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Employee Change Request Instructions Please complete only sections that are being updated. Employee Name Today s Date Effective Date SECTION 1 EMPLOYMENT STATUS Previous Employment Status - Check one Full Time Part Time Part Time Regular Previous FLSA Status - Check one Exempt Non-Exempt New Employment Status - Check one New FLSA Status - Check one Justification Please confirm with HR prior to changing an employee s FLSA status SECTION 2 WAGE / SALARY/ POSITION Current Wage / Salary per...
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