MASTER CHANGE FORM
REQUESTOR FIRST NAME:
*
REQUESTOR LAST NAME:
*
REQUESTOR EMAIL:
*
REQUESTED DATE:
*
-
Month
-
Day
Year
EMPLOYEE FIRST NAME:
*
EMPLOYEE LAST NAME:
*
EMPLOYEE PHONE NUMBER:
*
EMPLOYEE EMAIL:
*
JOB TITLE:
*
REPORTS TO:
*
TYPE OF CHANGE:
*
NEW HIRE
TRANSFER OR PROMOTION
CHANGE IN PAY
TERMINATION
NEW HIRE
ORIENTATION DATE:
*
-
Month
-
Day
Year
START DATE:
*
-
Month
-
Day
Year
HIRE STATUS:
*
NEW HIRE
REHIRE
BUSINESS UNIT:
*
CAT
DS
ENT
FSM (Use only if Salaried Employee is Floating / Training)
LOCATION:
*
EMPLOYMENT STATUS:
*
FULL TIME
PART TIME
INTERNSHIP
OTHER
PAY RATE:
*
PER HOUR / PER YEAR
PAY TYPE:
*
SALARY
HOURLY
Manager/Supervisor Position? (If yes, please list all employees that report to the new hire in the comment section below)
*
YES
NO
COMMENTS:
PLEASE LIST ALL DIRECT REPORTS IF THIS IS A MANAGER OR SUPERVISOR POSITION
SUBMIT CHANGE
TRANSFER OR PROMOTION
FROM POSITION
*
TO POSITION
*
LOCATION:
*
START DATE:
*
-
Month
-
Day
Year
BUSINESS UNIT:
*
CAT
DS
ENT
FSM
EMPLOYMENT STATUS:
*
FULL TIME
PART TIME
INTERNSHIP
OTHER
OLD PAY RATE:
*
PER HOUR / PER YEAR
NEW PAY RATE:
*
PER HOUR / PER YEAR
PAY TYPE:
*
HOURLY
SALARY
NO CHANGE IN PAY
MANAGER / SUPERVISOR POSITION? (IF YES, LIST ALL DIRECT REPORTS IN COMMENTS SECTION BELOW)
*
YES
NO
COMMENTS:
PLEASE LIST ALL DIRECT REPORTS IF THIS IS A MANAGER OR SUPERVISOR POSITION
SUBMIT CHANGE
CHANGE IN PAY
OLD PAY RATE:
*
PER HOUR / PER YEAR
NEW PAY RATE:
*
PER HOUR / PER YEAR
EFFECTIVE DATE:
*
-
Month
-
Day
Year
REASON:
*
Please Select
PRO - Promotion
RELO - Relocation
ADL - Additional Job Responsibilities
COL - Cost of Living
COR - Correction
EEREQ - Employee Request
MER - Merit
XFR - Transfer
SUBMIT CHANGE
EMPLOYMENT TERMINATION
LAST DATE WORKED:
*
-
Month
-
Day
Year
TERMINATION DATE:
*
-
Month
-
Day
Year
REASON:
*
Please Select
Location Closed
Did not return from leave
Job Elimination
No Call / No Show
Non-compliance with E-Verify
Performance / Neglected Duty
Violation of Company Policy
Quit / Resignation
Retirement
Deceased
VOLUNTARY / INVOLUNTARY?
*
VOLUNTARY
INVOLUNTARY
ELIGIBLE FOR REHIRE?
*
YES
NO
COMMENTS:
SUBMIT CHANGE
Should be Empty: