subject_line
Change of Status
* Employee Name
Employee ID
Location
Address Change Section
Address Change
Yes
No
The following forms are to be included
W4
Residency Certification
Per Diem Certification
W4 Form
Residency Certification
Per Diem Certification
Dates
Layoff
+
Rehire
+
Transfer
+
Transfer Section
Pay Rate
🛈
Per Diem
🛈
Truck Pay
🛈
Termination
Voluntary date
+
Involuntary date
(include documentation)
+
* Eligible for rehire?
Yes
No
Promotion
Promoted?
Yes
No
New Title
Company owned items that need returned or canceled
Vehicle / Keys ..
Vehicle
Fuel Card
Office key
None of the above
Administrative Items
Housing
Health Insurance
401 K
None of the above
IT items
Laptop
Tablet
Phone
Email Address
Apple Id
Egnyte
D.A.E.S.
RDS
HeavyJob
HeavyBid
E360
None of the above
Item Returned 1
Returned to Whom 1
Return Date 1
+
Item Returned 2
Returned to Whom 2
Return Date 2
+
Item Returned 3
Returned to Whom 3
Return Date 3
+
Item Returned 4
Returned to Whom 4
Return Date 4
+
Item Returned 5
Returned to Whom 5
Return Date 5
+
Item Returned 6
Returned to Whom 6
Return Date 6
+
Item Returned 7
Returned to Whom 7
Return Date 7
+
Item Returned 8
Returned to Whom 8
Return Date 8
+
Item Returned 9
Returned to Whom 9
Return Date 9
+
Item Returned 10
Returned to Whom 10
Return Date 10
+
Email
Does email need forwarded?
No
Yes
To Whom?
Do phone calls need forwarded?
No
Yes
To Whom?
Litigation hold needed for email & OneDrive?
No
Yes
Notes / Comments
Submitter Comments / Notes:
* Project Manager / Supervisor
Jason Nau
Jason Sloan
Scott Burkman
Scott Ross
Terry Bohannan
Other ...
Other Project Manager / Supervisor
* Form submitted by
🛈
Please note:
Clicking "Submit" will send this request to the payroll department and a copy will be sent to requestor.