Employment Status / Salary Change Form
HR/Payroll Form
Effective: Date: M/D/Y ( New Hire ( Termination/Leave ( Change ( Other
|Employee Name: |
|SECTION 1 – EMPLOYEE |
|Date of Hire: |Birth Date: M/D/Y |Sex (M or F): |
|Social Insurance Number: |Home Phone Number: |
|Direct Deposit info ( void chq attached |
|Confidential email Address for Pay Stub: |
|Home Address: |
|Emergency Contact (Name, Relationship, Address and Phone): |
|SECTION 2 – JOB INFORMATION |
|Effective Date: M/D/Y |Position Title: |
|Department: |
|SECTION 3 – EMPLOYMENT STATUS |
|Previous Employment Status - Check one: |New Employment Status - Check one: |
|( Full time ( Temporary/Contract |( Full time ( Temporary/Contract |
|( Part time ( Other:__________________ |( Part time ( Other: ______________________ |
|SECTION 4 – WAGE / SALARY |
|Effective Date: M/D/Y |
|Current Wage / Salary: $ per |New Wage / Salary: $ per |
|SECTION 5 - REASON FOR CHANGE |
|( New Hire/Rehire |( Illness/Disability (not covered by WCB) |
|( Wage / salary increase |( Illness/Disability (covered under WCB) |
|( Unpaid Leave (type: _____________________) |( Promotion/Transfer |
|( Employee Initiated personal info change |( Termination/Resignation |
|SECTION 6 – TERMINATION/LEAVE |
|Date of actual last day worked: |Date of last day paid to: |
|Vacation Owing: |Termination Pay, if applicable: |
|Leave or Termination Reason: |Date of planned return, if applicable: |
|( All company property has been returned |
|Additional Comments: |
|SECTION 7 – AUTHORIZATION |
|Immediate Manager’s Signature: |Date: |
|Employee Signature: |Date: |
Payroll Change Form
Instructions for Completion
| |
|Employee’s Full Name & Department should always be completed |
| |
|Send signed originals to HR – to be placed in the Employee’s file. |
|Employee Category |Sections to be Completed |
| | |
|New Employees |Section 1 – Employee Information |
| |Section 2 – Job Information |
| |Section 3 – Employment Status |
| |Section 4 – Wage/Salary |
| |Section 5 – Reason for Change |
| |Section 7 – Authorization |
| | |
| |Attachments: |
| |Signed Offer Letter |
| |Void Cheque |
| |Benefit Enrolment form |
| | |
|Promotion / Transfer |Section 2 – Job Information |
| |Section 4 – Salary Change |
| |Section 5 – Reason for Change |
| |Section 7 – Authorization |
| | |
|Wage / Salary Increase |Section 3 – Salary Change |
| |Section 5 – Reason for Change |
| |Section 7 – Authorization |
| | |
|Leave of Absence |Section 5 – Reason for Change |
| |Section 6 – Termination/Leave |
| |Section 7 – Authorization |
| | |
| |** Attach authorized Request for Leave form |
| | |
|Termination |Section 5 – Reason for Change |
| |Section 6 – Termination/Leave |
| |Section 7 – Authorization |
| | |
|Employee Change of Address / Phone Number/Email |Section 1 – Employee Information – for any of the following that has changed: |
| |Address/Telephone Number/Email/Banking |
| |Section 7 – Employee Authorization |
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