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Payroll Status Change Form - 3-Part


For payroll or employee status changes, one form does it all!

The Payroll/Status Change Notice – 3-Part form gives you an effective tool for documenting job and salary changes and a convenient way to keep and route records. Along with transfers and promotions, this handy form covers new hire information, leave of absence and separation details.

Updated to include a new payroll/status change reason "FLSA Reclassification".


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  • Provides written record of what is changing about status and why
  • Provides two extra copies for employee and for recordkeeping

Product Specifications:

  • Size: 8 ½” x 11”
  • Sold in packs of 50

Old Item #A2257