Employee Payroll Change Form
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1Employee Payroll Change Form
Today’s Date:
________________________
Effective Date:
____________________
Employee Name
Employee #
.
Address\Phone Change
e
New Address: ________________________________________________________________________
Cell
street
city
state
zip
Home
New Phone: (____)__________________
Other
Job Rate / Position / Department
Changee
Pay Rate Change:
From $___________
To $____________
Retroactive? Yes
No
If YES, to what date? _______________
Retro Pay $ _________
Rate Change is
Permanent
Temporary
(circle one)
Current Position / Department ______________________
Change To: ______________________
Reason: ____________________________________________________________________________
____________________________________________________________________________________
Deduction Change
e
Deduction Agency:
Vendor Name
Deduction Type
Effective Date
$ Amount
Comments:
Authorized by:
Acknowledged by:______________________Date:________
Supervisor
Employee
==================================================================
For HR Department Use Only
Date Entered:
Entered By:
Quicklist Updated
Payroll Updated
A/P Updated
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Parent category: Business