Employee Status Change
Date Completed
*
-
Month
-
Day
Year
Defaults to today's date
Employee Name
*
First Name
Last Name
Change Type
*
Please Select
Position/Rate Change
Separation/Termination
Bonus
Effective Date
*
-
Month
-
Day
Year
If this is a new job title and/or rate increase, what day does the employee start with the new title/earning the new wage? If this is a one-time Bonus, what payroll date should it be paid out?
Bonus Amount
*
Separation Reasons
*
Please Select
Termination
Resignation
Never Worked
Deceased
Justification and/or supporting statements should be entered into the employee's record in Avionte.
Last Day of Work
*
-
Month
-
Day
Year
Date
Eligible for Rehire
*
Yes
No
Are you located in Oregon?
*
Yes
No
Please chose the departure situation (it affects the timing of final pay):
*
Resigned with more that 48 hours notice
Resigned with no notice
Termination (by DPI)
No Pay Due
Comments:
0/100
Employment Changes (please convey an hourly rate, even if exempt position)
Change Reasons and/or Comments
0/100
File Upload (Supporting Documents)
Browse Files
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Originator Name
*
First Name
Last Name
Originator Email
*
example@example.com
Originator Signature
*
Department Head/Approver Email
*
example@thedpigroup.com
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