PAYROLL CHANGE NOTICE
For submission to HR and Finance
Date:*
Month Day Year
Employee Name:*
First Name Last Name
Current Title:*
Current Dept:*
Current Location:*
Change Effective Date:*
Month Day Year
Reason for Change:*
New Hire Merit Increase Layoff* Reinstated Promotion Suspension* Transfer Bonus Discharge* Demotion Retirement* Resignation*
Last Work Date:*
Month Day Year
* Items Retrieved From Employee:
Office Keys Cell Phone Laptop ID Badge Credit Card Car Key Key Fob Equipment Uniform Foster Animal
New Title:
^If title is not shown, specify in comment box
New Dept:
New Location:
Funding Source:
^If fund is not shown, specify in comment box
Current Pay Rate:
New Pay Rate:
Amount:
One Time Pay
Departments Notified:
IT Dept: To restrict access to all ACC accounts Finance: To restrict access to accounting database
Comments/Notes:
^Notes for Finance and/or HR
Form submitted by:*
^Supervisor/Manager or Director
Change approved by:*
CEO Signature:
Date:
Month Day Year
Risa Weinstock - Sign and Date
Attach file:
Browse Files
Cancelof
Should be Empty:

PAYROLL CHANGE NOTICE