Employee Status Change

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10/19 EXAMPLES

Text in this Example:

Company Name
YOUR LOGO HERE
Employee Profile
Employee Name:
Date:
Date effective:
EMPLOYEE STATUS CHANGE
Social Security:
Employment Changes
Classification Changes
New Hire:
Rehire:
Temporary:
Replacement:
Job Title:
Start Date:
Change
Old Information
New Information
Transfer:
Promotion:
Demotion:
Title:
Title/Dept:
Shift:
Location:
Salary:
Status:
Other Changes:
Notice of COBRA Rights?
Date Provided:
Election of COBRA?
Date Started: