Employee Name:  ____________________________________________________ Effective Date: _____/_____/_____ Change: (check appropriate reasons) Job Information:     Title       Supervisor     Work Schedule          Wages*:        Merit      Promotion      Adjustment * Please attach appropriate paperwork form for wage increase. Description of change: ________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Separation of Employment:   Resignation     Involuntary Termination Reason:___________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Eligible for rehire?      Yes       No Employee Signature ___________________________________ Date: _____/_____/_____ Manager Signature: ___________________________________ Date: _____/_____/_____