Download Payroll Change Form for Free

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EMPLOYEE NAME: _________________________________
EMPLOYEE NUMBER ______________________________________
New Address: ___________________________________
(if applicable)
New Phone Number: ____________________________
(if applicable)
EMERGENCY CONTACT NAME __________________________PHONE: ________________
ADDRESS: ______________________________________________
Effective Date: ____________________________
(changes must be effective the 1
day of a pay period)
Old Salary: ____________________________
(if applicable)
New Salary: ____________________________
(if applicable)
Change Type:
name change merit increase**
(certificate attached) (review attached)
address/phone # change discontinue Colonial
promotion/salary increase** reclassification**
discontinue United Way transfer**
extend probation** demotion**
discontinue deferred comp other
Reason For Change:
________________________ _____________
Employee Signature: Date:
________________________ _____________
**Department Head/Elected Official Signature** Date:
(Incomplete forms may result in processing delays)
Payroll Change Form
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