Personnel Change Form – Status Change

Employee Name*
First Last
Effective Date of Change*
MM slash DD slash YYYY
Status of:*
Avg. Weekly Hours*
Property Name & Number or Corporate Dept.*
General Ledger Accout*
Job Title*
Salary or Hourly Rate*
Annual Travel Allowance
Annual Phone Allowance
Other (Please provide details)
Manager Name*
First Last
Manager Email*
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