HR Payroll Change Form Template
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HR Payroll Change Form
Please complete this form to request changes to payroll information.
Employee Information
Name
Job Title
Department
Employee ID Number
Date of Request
Type of Payroll Change
Select One or More:
Change in Salary/Wage
Change in Hours
Change in Direct Deposit Information
Change in Tax Withholding
New Salary/Wage (if applicable)
Effective Date (if applicable)
New Scheduled Hours (if applicable)
Effective Date (if applicable)
New Bank Name (if applicable)
New Account Number (if applicable)
New Routing Number (if applicable)
Effective Date (if applicable)
New Federal Withholding (if applicable)
Single
Married
Exempt
New State Withholding (if applicable)
Single
Married
Exempt
Reason for Change
Promotion
Demotion
Transfer
Employee Request
Change in Role/Responsibilities
Approval and Authorization
Name:
Date:
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