JRDQ Employee Status Change Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Employee InformationName *FirstLastStore #Effective Date *Employment ActionSupervisor *FirstLastCurrent WageNew WageAction:Re-hiredPromotion/DemotionTerminatedTransferLeaveBenefit ChangePayroll DeductionOtherIf other, please explainReason for Action/Notes: *Employee Position & StatusNew ClassificationFull TimePart TimeSignaturesManager Signature *Clear SignatureEmployee Signature (if applicable) *Clear SignatureSubmit Useful links Paper Order Incident Order Supply Order School Sales Write up Form Maintenace Employee Status Payout Form
