| PAYROLL CHANGE NOTICE
DATE______________
| NAME |
DEPARTMENT |
SHIFT |
FILE NUMBER |
| EMPLOYEE NUMBER |
SOCIAL SECURITY NUMBER |
PAYROLL CLASS |
NEW JOB
DESCRIPTION
| TITLE |
DEPT. |
SHIFT |
| GRADE |
LOCATION |
OTHER |
IMMEDIATE
JOB HISTORY
| TITLE |
DEPT. |
SHIFT |
| GRADE |
LOCATION |
OTHER |
PAST JOB HISTORY
| TITLE |
DEPT. |
SHIFT |
| GRADE |
LOCATION |
OTHER |
| NEW JOB RATE |
REASON FOR
CHANGE |
| R |
PER HOUR |
|
R |
PER MONTH |
|
| R |
PER YEAR |
|
SIGNATURES
| EMPLOYEE SIGNATURE |
DATE |
DEPARTMENT SUPERVISOR |
DATE |
| SUPERVISOR SIGNATURE |
DATE |
PAYROLL DEPARTMENT |
DATE |
|