Employee File Status Change Employee to Update Selected Name Employer/Client Record Change Details Type of Change New Hire Name Change Pay Change Other Record Changes Terminated Change is Permanent Once Only Number of Pay Periods Effective Date Effective From Effective To Reason for Change(s) New Employee Promotion Periodic Review File correction Rehired OtherOther Reason for Termination Discharge Layoff Voluntary Quit OtherOther Employee Name if you are changing an existing user's name, please enter the full new name, first name, last and middle initial. First Name Mid Init Last Name Full Name Rate of Pay Choose New Pay Type HourlySalaryOther Pay Type Other Pay Type describe pay type Rate of Pay Other Record Fields Select New Dept Dept DOH Job Title Average Hours Email Termination Last Day Worked Termination Date Eligible for Rehire? Yes No Brief Explanation Other Other changes not listed this form, or Comments Supervisor Signature Clear Supervisor Email Please provide an email address if you'd like a copy of this change. Submitter Name If you are human, leave this field blank. Submit