Employee Status Change form

Employee ID:
NAME (FIRST & LAST): EFFECTIVE DATE (mm-dd-YY):

Change Requested by: ☐ Employee ☐ Supervisor/Manager ☐ HR ☐ Other:

PRESENT PROPOSED FINAL
LOCATION: LOCATION: LOCATION:
DEPT. NAME: DEPT. NAME: DEPT. NAME:
JOB TITLE: JOB TITLE: JOB TITLE:
WORK SHIFTS: WORK SHIFTS: WORK SHIFTS:
STATUS: ☐Full-time ☐ Part-time ☐ Contract: Start Date: Stop Date:
SALARY/WAGE: SALARY/WAGE: SALARY/WAGE:
Choose one: ☐Hourly, ☐Biweekly, ☐Monthly, ☐Annual
STATUS CHANGE - Please check off, circle accordingly, and attach the supporting document accordingly
☐New Hire/Re-Hire ☐Transfer/Relocation/Shift Change ☐Job Title Change
☐Employee Information Change ☐Promotion/Re-Evaluation ☐Leave of Absence/Return to Work
☐Termination/Resignation ☐Merit Increase ☐Other:
BRIEF REASON FOR THE ABOVE CHANGE

PERSONAL INFORMATION UPDATE (NO Approval Required) - Please check off the items that you wish to update
☐Address Update ☐Contact Number
Address 1 New Phone #
Address 2 ☐Work Authorization: SIN/SSN/NRIC Update *Attach
Proper Supporting doc.
City, Status: ☐PR ☐Citizen ☐Work Permit
Province/State
Postal/Zip Code ☐Bank info *Attach Direct Deposit form or Void Cheque
Country Institution #
☐Contact Email Transit #
New Email Account #
EMERGENCY CONTACT UPDATE (NO Approval Required) – NEW EMERGENCY CONTACT
Name Relationship
Contact Number Contact Email
Address

DATE Comment
Employee Signature (Month Day Year)
DATE Comment
Manager Approval (Month Day Year)
DATE Comment
HR Approval (Month Day Year)
Comment
CEO / Executive Approval (Month Day Year)

Name of person processing request: System Input: Date: