Employment Status Change
Store Number
*
Please Select
1637 (Manhattan Seth Child)
1692 (Andover)
1693 (47th & Broadway)
6311 (Manhattan Tuttle Creek)
6315 (Salina)
6316 (Junction City)
6321 (Augusta)
6327 (Trooper)
6346 (Derby)
6347 (Winfield)
6350 (Seneca)
6364 (Normandy)
6376 (37th & Woodlawn)
6391 (Park City)
6392 (Harry & Rock)
9631 (Huebner)
9635 (Ark City)
9636 (El Dorado)
9637 (Newton)
Employee
*
First Name
Last Name
Supervisor Area
*
Please Select
Dan Hohl
Todd Ebert
Nathan Lloyd
Current Employment Status
*
Please Select
Active
On Leave
Separation
New Employment Status
*
Please Select
Active
On Leave
Separated
Reason for change
*
Supporting Documents
Browse Files
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Choose a file
(2 weeks notice, final write ups, termination documents)
Cancel
of
Effective date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submitted by
*
First Name
Last Name
Position
*
Please Select
GM
Supervisor
Office
Submit
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