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PSOR HH KDQJH RUP This form is to be used whenever an individual s employment status changes. What type of change Name currently in payroll Last First MI Name if changed Last New Address-Street City Primary Supervisor ZIP Secondary Supervisor Effective Date of Change MM/DD/YYYY Current Title Location Payroll RL Location New Title Salary/Hourly Hours Biweekly Salary Exempt/Non-Exempt Exempt Dept Percentage Salary Biweekly/ Rate per hour Hourly Non-Exempt Healthcare Changes effective 1st of...
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