Employee Change Form
Download a blank fillable Employee Change 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 Change 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
1Please return to
IDEAL HR within
Employee Change Form
24 hrs
EFFECTIVE DATE: __________
Status/ Wage / Address
Employee Information
Status/Wage/Department/Job Title Change
(Check those that apply)
Client Company
______________________________
Hourly
Exempt
Part-time
Last Name_______________________________
First Name_______________________________
Salaried
Non-Exempt
Full-Time
Middle__________________________________
Average hours per day________ per week________
Address Change
Wage Amount:
From____________ To___________
Reason for wage increase:
Address:____________________________________
__________________________________________
City:________________________
New Department ______________________
State:_____________ Zip code______________
New Job Title _________________________
Phone:___________________________________
Email:___________________________________
Who will Manage the employee?
Who will the employee manage?
Leave of Absence
Does this change effect:
Type of Leave:
Will continue to earn Accruals
____Yes ___No
Will continue to receive Vacation ____Yes ___No
FMLA
o Personal/Discretionary
o
Jury Duty
Other
o
o
Does the employee have Health or Supplemental
Start Date:______________
Insurance? ____Yes ____No
Return Date:_____________
If Yes, How will the premiums be paid while the
Requires a medical release to return: ____Yes ___No
employee is on leave? ______________________
________________________________________
Reason for Leave: ____________________________
________________________________________
___________________________________________
Please contact our Benefits Department for any questions or
concerns (864)286-9009
I have authorized the above changes to be made as of the effective date listed above.
_______________________________________
___________________________
Signature of the Person Completing
Date
____________________________________________________
____________________________________
Signature - Additional Authorization
Date
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business