Office Use: Change of Status
Wage Adjustment
If no wage adjustment is being made only complete "Previous Rate" field
Employee Name
*
First Name
Last Name
Previous Rate:
*
New Rate:
*
Classification Change
If no classification change is being made only complete "Previous Classification" field
Previous Classification
*
Please Select
Full Time
Part Time
Temporary
Stipend
Other
New Classification
*
Please Select
Full Time
Part Time
Temporary
Stipend
Termination
Other
Reason for Change of Status
*
Notes (if Applicable)
Who is Completing This Form
*
By typing your name you are certifying that you have followed all required procedures for hiring this employee. Including but not limited to: budgetary approval, interviews, etc. You also certify that the above information has been completed to the best of your knowledge.
Submit
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