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Document Sample

Employee Status Change Form

Employee Name: ___________________________________________________ Social Security #: __________________________________

Address: ______________________________________________________________________________________________________________

DT #: ___________ Location Name: _________________________________ Position: ____________________________________________

Effective Date: ______/______/______

Date of Birth: ______/______/______ E-mail: ________________________________________

 

 

 

 

 

Employee Status

 

 

 

 

Type of Change:

New Hire

 

Rehire

Employee Status Change

Regular Full Time

(30 hours or more)

 

Hours per week: _________

Regular Part Time

(29 hours or less)

 

Hours per week: _________

Temporary

(Less than 6 months)

Hours per week: _________

On Call

(As Needed)

 

 

 

 

 

 

 

 

Salary Establishment/Change

 

 

 

 

 

 

 

 

 

Type of Change:

 

New Hire

 

Merit Increase

Promotion

Cost of Living

Other _______________________

New Pay Rate:

$__________________

per hour

 

Bi-weekly salary amount

Annual Salary $______________________

 

 

 

 

(Non-Exempt)

(Exempt)

 

 

(If Exempt)

IF SCHOOL EMPLOYEE: ( If contracted teacher, please attach a copy of the contract)

 

 

 

# of Pays: _____________

First Check Date: ______/______/______

Final Check Date: ______/______/______

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Status Change

 

 

 

 

 

 

 

 

 

 

Location Change (Transfer)

 

 

From_______________________________ To ________________________________

Position Change

 

 

From_______________________________ To ________________________________

Leave of Absence

 

 

From_______________________________ To ________________________________

Other

 

 

 

_______________________________________________________________________

 

 

 

 

 

 

 

 

 

 

Termination of Employment

 

 

 

 

 

 

 

 

 

Last Working Day: ______/______/______

 

 

 

 

 

 

 

Eligible for rehire?

Yes

No (if no, list reason) _______________________________________________________________

Select ONE reason for separation:

 

 

 

 

 

 

 

 

Voluntary:

 

 

 

 

 

 

 

 

 

 

Dissatisfied w/ job or company

Retirement

School

No Call/No Show

 

Better job/pay/benefits/hours

Medical-self or family

 

Relocating

Family issues

Other________________________________________________

Involuntary:

 

 

 

 

 

 

 

 

 

 

Poor performance

 

 

Gross Misconduct

Contract Ended

 

Unqualified for job

Violation of company policy/procedure

 

Unprofessional conduct

Other________________________________________________

 

 

 

 

 

 

 

 

 

 

 

Remarks:______________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

Parish/School/Agency Signature:______________________________________________________________ Date:_______________________

Document Information

Fact Name Description
Purpose The Employee Status Change form is used to document changes in an employee's status, such as promotions, demotions, or terminations.
Required Information This form typically requires details such as the employee's name, position, department, and the nature of the change.
Submission Process Employees or supervisors must submit the form to the HR department for processing.
State-Specific Forms Some states may have specific requirements or forms that align with local labor laws.
Governing Laws In California, for example, the form must comply with the California Labor Code regarding employee rights and status changes.
Record Keeping Employers are required to keep a record of all status changes for a specified period, often for compliance purposes.
Impact on Benefits Changes in employee status can affect benefits eligibility, such as health insurance and retirement plans.
Notification Employees should be notified of the changes and any implications they may have on their employment or benefits.

Employee Status Change - Usage Guidelines

Completing the Employee Status Change form is a crucial step in ensuring that all personnel records are up-to-date. After filling out the form, it will be submitted to the HR department for processing. Accurate information is essential to avoid any delays in the transition.

  1. Begin by entering the employee's full name in the designated field.
  2. Provide the employee's identification number or employee ID.
  3. Select the current status of the employee from the dropdown menu. Options may include full-time, part-time, or temporary.
  4. Indicate the new status the employee will be transitioning to, if applicable.
  5. Fill in the effective date of the status change. Ensure this date is accurate to prevent any administrative errors.
  6. Include any relevant comments or notes that may assist HR in processing the change.
  7. Review all information for accuracy before submitting the form.
  8. Sign and date the form to verify that all information is correct.
  9. Submit the completed form to the HR department either electronically or in person, as per your organization's protocol.

Dos and Don'ts

When filling out the Employee Status Change form, there are important dos and don'ts to keep in mind to ensure accuracy and compliance.

  • Do double-check your personal information for accuracy.
  • Do clearly indicate the reason for the status change.
  • Do sign and date the form before submission.
  • Do keep a copy of the completed form for your records.
  • Do submit the form to the appropriate HR representative promptly.
  • Don't leave any sections blank unless instructed.
  • Don't use abbreviations or unclear language.
  • Don't forget to notify your supervisor of the change.
  • Don't submit the form without reviewing it for errors.
  • Don't delay in submitting the form if a change is imminent.

Common mistakes

  1. Incomplete Information: Many individuals fail to provide all required details. Missing fields can delay processing and create confusion.

  2. Incorrect Dates: Entering the wrong dates for changes, such as employment start or end dates, can lead to payroll errors and affect benefits eligibility.

  3. Not Updating Job Titles: When employees change roles, they often forget to update their job titles on the form. This oversight can lead to discrepancies in records and responsibilities.

  4. Neglecting to Sign: Failing to sign the form is a common mistake. Without a signature, the form may be considered invalid, causing delays in processing.