The Employee Status Change form is a document used by organizations to officially record changes in an employee's status, such as promotions, transfers, or terminations. This form ensures that all relevant departments are informed and can update their records accordingly. Proper completion of this form is essential for maintaining accurate employee information and ensuring compliance with company policies.
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Employee Status Change Form
Employee Name: ___________________________________________________ Social Security #: __________________________________
Address: ______________________________________________________________________________________________________________
DT #: ___________ Location Name: _________________________________ Position: ____________________________________________
Effective Date: ______/______/______
Date of Birth: ______/______/______ E-mail: ________________________________________
Employee Status
Type of Change:
New Hire
Rehire
Employee Status Change
Regular Full Time
(30 hours or more)
Hours per week: _________
Regular Part Time
(29 hours or less)
Temporary
(Less than 6 months)
On Call
(As Needed)
Salary Establishment/Change
Merit Increase
Promotion
Cost of Living
Other _______________________
New Pay Rate:
$__________________
per hour
Bi-weekly salary amount
Annual Salary $______________________
(Non-Exempt)
(Exempt)
(If Exempt)
IF SCHOOL EMPLOYEE: ( If contracted teacher, please attach a copy of the contract)
# of Pays: _____________
First Check Date: ______/______/______
Final Check Date: ______/______/______
Status Change
Location Change (Transfer)
From_______________________________ To ________________________________
Position Change
Leave of Absence
Other
_______________________________________________________________________
Termination of Employment
Last Working Day: ______/______/______
Eligible for rehire?
Yes
No (if no, list reason) _______________________________________________________________
Select ONE reason for separation:
Voluntary:
Dissatisfied w/ job or company
Retirement
School
No Call/No Show
Better job/pay/benefits/hours
Medical-self or family
Relocating
Family issues
Other________________________________________________
Involuntary:
Poor performance
Gross Misconduct
Contract Ended
Unqualified for job
Violation of company policy/procedure
Unprofessional conduct
Remarks:______________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
Parish/School/Agency Signature:______________________________________________________________ Date:_______________________
When an employee's status changes, various forms and documents may be necessary to ensure a smooth transition. These documents help maintain accurate records and facilitate communication between departments. Below is a list of common forms used alongside the Employee Status Change form.
Each of these forms plays a vital role in managing employee records and ensuring compliance with company policies. Proper use of these documents can help streamline HR processes and improve communication within the organization.