Employee File Status Change

Employee to Update

Record Change Details

Type of Change
Change is
Reason for Change(s)
Reason for Termination

Employee Name

if you are changing an existing user's name, please enter the full new name, first name, last and middle initial.

Rate of Pay

describe pay type

Other Record Fields


Termination Date
Eligible for Rehire?


Please provide an email address if you'd like a copy of this change.