Free HR Payroll Change Form Template
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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