PAYROLL CHANGE NOTICE CITY OF WAUPACA
Date Effective Employee Department Check Applicable Item
From
To
Department Job Shift Rate Working Foremen Number of hours to be paid REASON FOR CHANGE (S) (
) Hired
(
) Probationary Period
(
) Re-Hired
(
) Longevity
(
) Promotion
(
) Re-Evaluation of Job
(
) Demotion
(
) Transfer
(
) Merit Increase
(
) Union Scale
(
) Other (Explain)
If this is a new hire or new position do you expect this employee to work more than 12 consecutive months? _____yes _____no Do you expect this employee to work more than 23 hours per week? _____yes
Change Authorized by
_____no
