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Personnel Change Notice

__ Employment __ Terminate __ Change


Explanation________________________________
Employee Employee # S. S. # Grade Level
Address City State Phone
Job Title epartment Lo!ation Phone
Employment
__"e# $ire __%ehired __Temporary __Part Time __%epla!ement &or'
$ire ate Start ate Age Sex (arital Stat)s Ed)!ation Shi*t
Termination
__+ol)ntary __,nvol)ntary Last ay -or.ed Pay Thro)gh ate %ehire/ __0__"
$ire ate Start ate Paid ays A!!r)ed Severan!e Pay Approved/ __0__"
Change
__ %ate1Salary __ Job __ Lo!ation Leave o* Absen!e' &rom ___________ To __________
Lo!ation Change To' &rom'
Job and Salary Change 2ld Title1Salary "e# Title1Salary
Comments
Approval Signatures
Prepared 3y' ate S)pervisor' ate
A)dited 3y' ate Personnel' ate
Employee' ate Personnel' ate

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