Notice of Employee Change
Current Employee Information
Employee Name
Job Title				Employee Number
Department				Social Security Number
Personal Information
Employee Name		From				To
Address
City State Zip
Phone Number
Marital Status
Job Position Information
Job Title	From				To
Department
Supervisor/ Manager
Salary	$ per [ ] Hour [ ] Month				$ per [ ] Hour [ ] Month
Effective Date
Reason Code	Promotion [ ] Reclassification [ ] Transfer [ ] Demotion [ ] Adjustment [ ] Merit [ ]
Review Date	Current				Next
FLSA Status	NonExempt [ ] Exempt [ ]
Employee Status
Change in Status	[ ] Leave of Absence [ ] Lay Off [ ] ________________ [ ] Return to Work [ ] Termination
Effective Date
Reason for Change
Approvals
Supervisor			Human Resources
Manager			President

SOURCE: hrVillage.com
Human Resources