2022-08-29_shameema.cadersaibe_Taneshia Persaud - Termination Status Change Form.docx

Employee Status

Salary/Position/Job Change/Transfer

Termination of Employment

Remarks:

Employee Name: | Employee #:

Current Position Title: | Location: Choose

Effective Date: | Effective Date:

Type of Change:

Change Reason:

Location Change:

Regular Full Time
   Regular Part Time
   Temporary (Short Term)
   Other:

Comments:

New Position Title:

Supervisor/Manager:

Current Pay Rate: $           Hourly                 Annually
New Pay Rate: $                 Hourly                 Annually
  Exempt (Salaried)                      Non-Exempt (Hourly)

Comments:

Last Working Day:

Reason For Separation: 
Voluntary: 
Involuntary: 
Other:

Comments:

Prepared by: | Date: