PAYROLL CHANGE REQUEST

Employee's Name: 	 	_ 	_

Social Security Number: 	_

Date: 	_

Clock  Number: 	_

New Hire	Employment Status
Rehire	      	       Full time to part-time
Promotion	       Part-time to full time
Merit Increase	       Temporary
Transfer	       Summer employment
Demotion   	       Internship
Resignation	       Job Share
Discharge
Layoff
Retirement
Leave of Absence
Length of Service
Completion of Introductory Period
Other				

 

CHANGE	FROM	TO	EFFECTIVE
DATE	
Position				
Department				
Rate				
Other				

     

Reason for Change

AUTHORIZATIONS

Recommended by: 	_  Date: 				
Approved by: 	_   Date: 			

Northeastern Retail Lumber Association 12-11

_Copy to:   Payroll
                    Department  Head
                    Personnel