Sample Company Status Change Form
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1SAMPLE COMPANY
STATUS CHANGE FORM
For use for new hires/termination/promotion/salary change/billing rate changes/leaves
TYPE OF CHANGE: (check all those that apply)
COMPLETE SECTIONS:
NEW HIRE
?
A/B/C/I
EMPLOYMENT STATUS CHANGE
?
A/B/I
SALARY CHANGE
?
A/D/I
JOB CATEGORY CHANGE
?
A/E/I
LEAVE OF ABSENCE
? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
A/F/I
TERMINATION/RESIGNATION
?
A/G/I
NAME?
DEPARTMENT?
A
POSITION TITLE?
EMPLOYEE NUMBER?
B
STATUS?
FULL TIME ?
PART TIME ? ________ /HRS WEEK
CONTRACT ?
START DATE?
PAY RATE?
SALARY ?$__________
HOURLY ?$__________
C
END OF CONTRACT?
BENEFITS ELIGIBILITY DATE?
CONTRACT RENEWAL DATE?
VACATION ACCRUAL RATE?
CURRENT SALARY?
NEW PAY RATE?
D
CURRENT HOURLY?
EFFECTIVE DATE?
EFFECTIVE DATE?
E
NEW POSITION TITLE? ?
DEPARTMENT?
NEW JOB CATEGORY?
F
LEAVE CATEGORY?
EXPECTED RETURN?
EFFECTIVE DATE?
OTHER?
G
LAST DAY OF ACTIVE
NOTICE PERIOD (WEEKS/DAYS)?
EMPLOYMENT?
OTHER?
REASON FOR LEAVING?
I
APPROVAL?
DATE?
COMMENTS?
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Parent category: Business