a EMPLOYEE STATUS REPORT
"APPROVED BY
Ee get MANAGER
LocaTion AREAWANAGER
HOME OFFICE
NAME: DATE OF BIRTH n08
STARTING SALARY
jereScTVeoAT eee a CHECK HERE IF REHIRE
‘STARTING WEEKLY SALARY. (OR HOURLY WAGE 2
RAISE REQUEST
EFFECTIVE DATE.
WEEKLY SALARY: FROM 10
HOURLY WAGE: FROM 10
‘TRANSFER (SENT FROM NEW STORE)
EFFECTIVE DATE
FROM (LOCATION)
To wocarion ie i
TERMINATION
EFFECTIVE DATE
REASON FOR SEPARATION: INVOLUNTARY ___ VOLUNTARY omer
EXPLANATION
OTHER REMARKS.
{FL OUT THEW FORMAT SAME TE THE APPLIGATON IS FLLED OUT)
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(ev 202) Employee's | 's Withholding ‘Allowance Certificate
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