DAEMEN COLLEGE
PAYROLL / EMPLOYEE STATUS CHANGE FORM
Employee Name: __________________________________________________________ Date of Change: ______________
Supervisor: ______________________________________________ Department: ________________________________
NOTE: Pay rate changes are effecve the start of a new pay period.
Send completed Payroll/Status Change Forms to the Office of Employee Engagement, DS 126
CHANGE FROM TO
Department
Job Title
Supervisor
Shi
Rate of Pay
Spend (Note Budget #)
Classificaon Change (Adm.,Fac., Staff)
Status Change (FT/PT)
Locaon / Room
Extension
Mail Box
REASON FOR CHANGE
COMMENTS
r Promoon
r Demoon
r Transfer
r Merit Increase
r Wage Scale Change
r Probaonary Period Completed
r Length of Service Increase
r Re-evaluaon of Exisng Job
r Increased Responsibilies
r Resignaon
r Rerement
r Layoff
r Discharge
r Suspension ___ Paid ___Unpaid
AUTHORIZATION
Requested by: ____________________________________________________________ Date: ______________________
Approved by: ____________________________________________________________ Date: ______________________
Business Office: __________________________________________________________ Date: ______________________
Budget Verified:
r Yes r No
SALARY CHANGES MUST BE APPROVED BY BUSINESS OFFICE
Employee Engagement/Payroll: ________________________________________ Date Entered: ____________________
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