Coolray Heating and Cooling, LLC CHANGE OF STATUS

EMPLOYEE INFORMATION

Today's Date * +

Effective Date of Change +

Employee Name *

Job Title *

Dept | Division *

Supervisor/Manager *

NEW STATUS

Reason:

Enter Current & New (change to) Information (enter all that apply):

	Current	New
Annual Salary (Exempt)	Current	New
Hourly Rate (Non-exempt)	Current	New
Job Title	Current	New
Department \| Division	Current	New
Supervisor	Current	New
Classification (FT,PT, Seasonal)	Current	New
Install Bonus Change	Current	New

LEAVE OF ABSENCE

Employee must request and complete paperwork provided by Human Resources before any Leave of Absence can be approved. Disability, WC and FMLA leaves may run concurrently. Personal/Non-FMLA Leaves of Absence must be approved by the President, Tim Smith.

Type of Leave:

Leave Start Date +

Leave Return Date +

DATA CHANGE

Note: Proper documentation supporting name change & marital status is required, please forward to Human Resources immediately upon receipt.

Enter Current & New (change to) Information:

	Current	New
Name	Current	New
Marital Status	Current	New
Address	Current	New
Home Phone	Current	New
Cell Phone	Current	New
Personal Email	Current	New

Comments/Notes:

AUTHORIZATION

If required, select the approving Executive/Manager/Supervisor below and the request will automatically be sent to them via email.

Select Approver

By using your mouse to sign your name in the space provided below you are authorizing the request on this form to be implemented.

Manager/Supervisor Signature *

clear

SUBMIT

Once you click SUBMIT you will receive a SUCCESS message notifying you that the form has automatically been emailed to Human Resources.

If you would like to have a copy of the completed CHANGE OF STATUS FORM emailed to your email please enter your Coolray email address in the space provided.

Supervisor/Manager Email (Optional)