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 *FirstLastOriginal Hire Date - (Only needed for Terminations)Store #Effective Date *Employment ActionSupervisor *FirstLastCurrent Wage - If changingNew Wage - If ApplicableAction:Re-hiredPromotion/DemotionTerminatedTransferLeaveBenefit ChangePayroll DeductionOtherIf other, please explainReason for Action/Notes: *Employee Position & StatusNew ClassificationFull TimePart TimeLast Day Worked (for terminations only)Eligible For Rehire? *YesNoN/ASignaturesManager Signature * Clear Signature Employee Signature (if applicable) * Clear Signature Submit Useful links Paper Order Incident Order Supply Order School Sales Write up Form Maintenace Employee Status Payout Form
