Payroll/ Associate Change Form CHANGE INFORMATION EFFECTIVE DATE / FIRST NAME M.I. LAST

Payroll/ Associate Change Form

CHANGE INFORMATION EFFECTIVE DATE FIRST NAME M.I. LAST NAME

CHANGE FROM TO

HOURLY RATE OR ANNUAL SALARY

INCENTIVE PAY PERCENTAGE

SALARY LEVEL

JOB TITLE

DEPARTMENT NUMBER

MANAGER (REPORTING STRUCTURE)

OTHER NEW HIRE (OR REPLACEMENT) *If replacement, for whom:

PROMOTION WAGE ADJUSTMENT

TRANSFER RETIRED/RESIGNED DISCHARGE *Select a reason below*

Absenteeism Gross Misconduct Job Elimination Layoff

Failed to return from leave Performance Quit w/out notice Other:

* Please refer to the Approval Matrix to obtain necessary signatures. REQUIRED SIGNATURES DATE MANAGER

PLANT MANAGER or DATE DC/ DIRECTOR DATE VP DIVISION DATE VP FINANCE DATE HUMAN RESOURCES DATE CEO ADDITIONAL COMMENTS

HR USE ONLY

EEO REQ.# Direct Reports Y N **Reminder: Please generate a PCN for direct report changes and send email notification.** Direct Indirect Salaried

1.800.999.04000 STANDARDTEXTILE.COM