Employee Status Change Request Form
Download a blank fillable Employee Status Change Request Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Employee Status Change Request Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Employee Status Change
Request Form
To be completed by Supervisor. Submission of this request does not give Supervisor authority to make any
changes. *Effective date of change in payroll system will coincide with employee signature date.
Employee: __________________________________________
Currently paid out of: (program, code & %)
Program
Code
%
__________
__________
_________
Current Work Location:________________________________
__________
__________
_________
Current position:_____________________________________
__________
__________
_________
Employees Current ADP Supervisor:___________________
__________
__________
_________
Changes/additions requested
_____ Additional work hours
from ___________ to ___________
To be paid out of: (program, code & %)
_____ Add another position in addition to current _________________________
Program
Code
%
__________
__________
_________
_____ Change in work hours
from ___________ to ___________
__________
__________
_________
_____ Change in work weeks/yr
from ___________ to ___________
__________
__________
_________
_____ Change in location
from ___________ to ___________
__________
__________
_________
_____ Change in position
from ___________ to ___________
__________
__________
_________
__________
__________
_________
_____ Change in rate of pay
from ___________ to ___________
__________
__________
_________
*Effective date of change: __________________________________ *(see above)
Employees New ADP Supervisor
Information to be entered into ADP:
_______________________________________
Specific Daily Hours for position: M____________T____________W____________Th____________F____________
Reason for all requested changes: (please be as specific as possible including names etc.)
Supervisor filling out form Signature_______________________________ Date_____________________________
Director’s Approval Signature____________________________________ Date_____________________________
For HR Department use only:
Staff signature required
__________ Approved—Effective date
Yes or No
HR Dept. Signature
__________________________________
Date:
__________________________________
** Form to be used for current Employee CHANGES or ADDITIONS
updated: 4/11/2012
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business