b'Document Employee Performance Record and Communicate Payroll ChangesComplyRight Consecutive Employee Warning Report Payroll/Status Change NoticePayroll/Status Change NoticePlease PrintDocument all employee infractions, especially those Please PrintPayroll ______________________________________Charlie Schuster12541AccountingRouting with multiple occurrences. Distribute written warningEffective Date of 68 16 New Hire Change Separation //RoutingChange_____________ ___________________Payroll___________________ SomnerJaniceChangeMiddleSeparationEmployee Name_____________________________________________________________________________________________//Effective Date of Change _____________ New HireLast Firstslips for up to three infractions and record the datesxxx -xx-2412 12541AccountingEmployee Name_____________________________________________________________________________________________Social Security # _____________________________Employee/Payroll # ____________Dept. _____________________________Payroll Change Notice LastFirstMiddleSocial Security # _____________________________Employee/Payroll # ____________Dept. _____________________________and reasons for each warning.Address____________________________________________________________________________________________________ 3641 Main RoadHollywood FL 33321StreetCityStateZIP Code 954 541-1212Date of Birth (for administrative use only) __________________/ /Address____________________________________________________________________________________________________() Street Telephone #_______________________________ CityStateZIP Code8318 11-7-1612541xxx-xx-2412 Status:Full-TimePart-TimeFull-Time TemporaryDate of Birth (for administrative use only) __________________ Date _____________________ I.D. # ___________________ Social Security # ____________________________ Telephone #_______________________________ Part-Time TemporaryOther ______________________/ /()Save time with duplicate warning slips Name _______________________________ Title ___________________________ Classification ___________________ Job Title _______________________________ Hourly Other ______________________ 7-28-187 late daysJanice Lauffer Clerk Level 1 Status: Clerk Exempt Non-Exempt W-4 Attached? Yes No Full-TimePart-TimeFull-Time TemporaryPart-Time TemporaryNo response Street Address _______________________________________________________________________________Exempt Non-Exempt HourlyW-4 Attached? Yes NoJob Title _______________________________3641 Main Road Change(s) for Current EmployeeCapture necessary documentation on repeat Change(s) for Current Employee FromToCommentsType Hollywood, FL 33321 954 541-1212 Address Change FromToCommentsreduce compensation City/State/ZIP __________________________________________________Phone () _______________ Type_____________________________________________________________________________________________offenders and actions takenemotion _____________________________________________________________________________________________D Address ChangeCharlie Schuster 8 5 17Barbara Howard District 1Accounting8:00 - 5-00epartment_____________________________________________________________________________________________Division _________________________Department _____________________Shift ________________________ Demotion _____________________________________________________________________________________________ D _____________________________________________________________________________________________ Department _____________________________________________________________________________________________Check appropriate box: FLSA Reclassification _____________________________________________________________________________________________ Includes a ComplyRight guide to help you documentFLSAReclassification _____________________________________________________________________________________________ 401(k)/403(b) Contribution __________________________________________________________________________________________________________________________________________________________________________________________ Enter on Payroll Transfer to:(Department)_______________________________401(k)/403(b)Contribution _____________________________________________________________________________________________ Insurance Eligibilityand discipline employees the right wayInsurance Eligibility _____________________________________________________________________________________________Job Title _____________________________________________________________________________________________ Change Rate Change Shift to: __________________________________________Job Title _____________________________________________________________________________________________Change of Insurance _____________________________________________________________________________________________Change of Insurance _____________________________________________________________________________________________Layoff _____________________________________________________________________________________________Layoff _____________________________________________________________________________________________ Remove from Payroll Change Withholding Rate(complete new W-4 form)of Service Increase _____________________________________________________________________________________________Lengthof Service Increase _____________________________________________________________________________________________ Length _____________________________________________________________________________________________ Change Title to: ______________________________________ Merit Increase_____________________________________________________________________________________________FLSA Reclassification Merit IncreaseItem #Price End of Introductory Period _____________________________________________________________________________________________End of Introductory Period _____________________________________________________________________________________________Change Status to Full-TimePart-Time Temporary Promotion _____________________________________________________________________________________________ P romotion _____________________________________________________________________________________________DL1-A2187$82.49 R eevaluation of Current Job _____________________________________________________________________________________________ R eevaluation of Current Job _____________________________________________________________________________________________Leave of Absence: Paid? Yes No Return (Date of return to work)________________________________ehire _____________________________________________________________________________________________ R R ehire _____________________________________________________________________________________________ Price per pkg/50. 4-part carbonless. Payroll Change Notice Resignation _____________________________________________________________________________________________ResignationAddress/Information Change ________________________________________________________________etirement _____________________________________________________________________________________________R Retirement __________________________________________________________________________________________________________________________________________________________________________________________Size: 8" x 11"________________________________________________________________ S alary/Wage _____________________________________________________________________________________________Salary/Wage _____________________________________________________________________________________________ Payroll Change Notice Separation _____________________________________________________________________________________________Date ________________ I.D. # ______________ Social Security # ____________________ _____________________________________________________________________________________________ Separationhift Change _____________________________________________________________________________________________S Shift Change _____________________________________________________________________________________________ Name _______________________ Title ___________________ Classification _____________ _____________________________________________________________________________________________Transfer Transfer _____________________________________________________________________________________________ Date EffectiveHourSocial Security # ____________________U U nion Scale _____________________________________________________________________________________________ Date ________________ I.D. # ______________ nion Scale _____________________________________________________________________________________________ Street Address ____________________________________________________________Other ______________Other ______________ Old Rate __________________Per ________________Title ___________________ Classification _____________Name _______________________City/State/ZIP______________________________________ Phone (Leave of Absence Begin Leave______________ Return from Leave / / Leave of Absence Begin Leave______________ Return from Leave/ /) ____________ / / ________________/ / ________________Street Address ____________________________________________________________Personal Family/Medical Leave(Including Pregnancy) EducationalNew RatePer Division ___________________ Department ______________Shift __________________Personal Family/Medical Leave(Including Pregnancy) Educational City/State/ZIP______________________________________ Phone ( ) Short-Term Disability Long-Term Disability Other ______________________________ ____________Long-Term Disability Other ______________________________ Short-Term DisabilityCheck appropriate box:Date of Last Payroll Change _________________________Separation_________________ / / / /Separation Separation Date/ / Last Day Worked _________________ Last Day Paid_______________/ / / / / / Division ___________________ Department ______________Shift __________________ Separation Date _________________ Last Day Worked _________________ Last Day Paid_______________ / /Enter on PayrollTransfer to: (Department) _________________________ Involuntary SeparationNotice of COBRA Rights Provided on_____________/ /Check appropriate box:Voluntary Separation Involuntary SeparationNotice of COBRA Rights Provided on_____________ Voluntary SeparationReason for Payroll Change Change Rate Change Shift to: ___________________________________YesNo Start Date of Coverage_______________/ / Transfer to: (Department) Election of COBRAYesNo Start Date of Coverage_______________/ /Election of COBRAEnter on Payroll _________________________If yes, describe type of coverage elected:_____________________________________________________________________________Merit Increase See Performance AppraisalNew Employee Change Withholding Rate (complete new W-4 form)_____________________________________________________________________________Remove from PayrollIf yes, describe type of coverage elected: Change RateChange Shift to: ___________________________________FLSA Reclassification:Additional Comments________________________________________________________________________________________________Promotion Other ________________________________________________________________ Additional Comments ________________________________________________________________________________________________Change Title to: ________________________________Remove from PayrollChange Withholding Rate (complete new W-4 form)__________________________________________________________________________________________________________________________Change Status toFull-TimePart-TimeTemporary __________________________________________________________________________________________________________________________Reason for Termination: (Please complete Exit Interview form.) FLSA Reclassification:Change Title to: ________________________________ (Optional)_________________________________________________________________________Date ________________Employee SignatureName and Title / /Employee Signature(Optional) Name and Title / / Leave of Absence: Paid?YesNoReturn (Date of return to work)_____________________________________________________________________________________________Date ________________Change Status toFull-TimePart-TimeTemporary / /Voluntary DischargedLaid Off Other Supervisor/Designated Manager Signature_____________________________________________________________Date ________________ Leave of Absence: Paid?YesNoReturn (Date of return to work) Supervisor/Designated Manager Signature_____________________________________________________________/ / Address/Information Change _______________________________________________Name and Title Date ____________________________________ Name and Title / /Human Resources/Payroll Manager Signature ___________________________________________________________Date ________________Remarks: __________________________________________________________________________________________ Human Resources/Payroll Manager Signature ___________________________________________________________Date ___________________________________________________________________________________ Name and Title / / Address/Information Change _______________________________________________ Name and Title _______________________________________________________________________________________o This rpvriocdesu.c Tt hisediensfiogrnmedat itoo np irso pvirdoev iadcecdu rwatiteh a tnhdeauuntdheorrsittaantidvein ign ftohramt aantiyo pne. rHsoonw eovre ern, itti tiysinnovto alv seudb isnti tcurteea tfoinrg l,e pgraol daducviicnegaonr dd disotreisb nuotitn pgr othviisd pe rloegdaulc ot pisi nnioont lsi aobnl ea nfoyr s apneyc idfiacm faacgtessoarri sseing out of the use or inability to use this product. You are urged to consult an attorney concerning your particular situation and any specific questions or concerns you may have.___________________________________________________________________ This product is designed to provide accurate and authoritative information. However, it is not a substitute for legal advice and does not provide legal opiniootn lsi aobnl ea nfoyr s apneyc idfiacm faacgtess General FactorsRatingScaleSupportive Details or Comments Date EffectiveHour arr issienrgvi oceust.oTf hteh ein ufsoer mora itnioanb iilsi tpyr toov iudseed t hwiist hp rtohdeu ucnt.d Yeorsut aanrde iunrgg etdh atto a cnoyn psuerlts oannoatrt eonrntietyycinovnoclevrendi ningcyroeuart ipnagr,t picruodlaurc siintug aotri odni satnridb uantiyn gsp tehciisf picr oqduuesctti oisn ns or concerns you may have.Important note: This is approved for use by the purchaser only. This form may not be shared publicly or with third parties. _______________________________________________________________________________________ 22011668 ComplyRight, Inc. Important note: This is approved for use by the purchaser only. This form may not be shared publicly or with third parties. 7.CreativityThe extent to which anO 100-90Points Old Rate ______________Per ____________ 22011668ComplyRight, Inc. Two easy ways to reorder: hrdirect.com800-999-9111Date EffectiveHour Aemployee proposes ideas, finds newV89-80_______________________________________________________________________________________ A Two easy ways to reorder: hrdirect.com800-999-9111and better ways of doing things.G79-70 New Rate______________Per ____________Old RatePer I69-60 Date of Last Payroll Change __________________ 3-Part CarbonlessNew RatePer UBelow 60 Submitted By__________________________Title ___________________________ Date __________________Date of Last Payroll Change __________________8.InitiativeThe extent to which an employeeO100-90ormance Appraisal ComplyRightApproved By __________________________Title ___________________________ Date __________________Perf Points Reason for Payroll Changeseeks out new assignments and assumesV89-80 Please Print Reason for Payroll Change New Employeeadditional duties when necessary. G79-70Steve Mullins TiMarketing Assistant Performance Appraisal This product is designed to provide accurate and authoritative information. Howetv aenr,y i tp iesr nsoontao sr uebnsttitityu itnev foolrv leedg ainl a cdrveaictein agn, dp rdoodeus cniontgporro dviisdter ilbeguatiln ogp tinhiios nprs oodnu acnt yis New EmployeeMerit IncreaseSee Performance Appraisal I 69-60 specific facts or services. Tharei sininfgo romuta toifo nth iesupsreo voird ienda wbiiltihty t thoeuusned tehrisst apnroddinugc tt.h Yaou are urged to consult an attorney concerning your particularUEmployee Name __________________________________________ tle _____________________________________________ niotut alitaiobnleafonrdaannyydspamecaifgiecsquestions or concerns you may have. Merit IncreaseSee Performance Appraisal Below 60 s PromotionOther __________________________________________ Marketing Employee Payroll #__________________________________ APromotion Other __________________________________________Important note: This is approved for use by the purchaser only. This form may not be shared publicly or with third parties.9.Adherence to PolicyThe extent to which an ODepartment _____________________________________________ 345-66-9090 22011760 ComplyRight, Inc. Two easy ways to reorder: hrdirect.com800-999-9111 Reason for Termination: (Please complete Exit Interview form.)100-90Pointsemployee follows safety and conduct rules, otherVRe89-80 AnnualPromotionPeer AppraisalUnsatisfactory Performance Simplify the performance review process Reason for Termination: (Please complete Exit Interview form.) Otherason for Review VoluntaryDischargedLaid Off regulations, and adheres to company policies.G 79-70 MeritEnd of Introductory PeriodOther_________________________________VoluntaryDischargedLaid OffOther ID69-60resent positn ___// Date of last appraisal ____//Scheduled appraisal date___// 19 and provide your employees a clear way Standard Remarks: ____________________________________________________________________ ate em io__________ 315 183 1 7 Remarks: ____________________________________________________________________Below 60ployee began p 313 18 __________ _________UInstructions: Carefully evaluate employees work performance in relation to the essential functions of the job. Check Rating box that____________________________________________________________________10. Interpersonal RelationshipsThe extent to O indicates the em ____________________________________________________________________100-90 Poinplotsyees performance. Indicate N/A if not applicable. Assign points for each Rating within the Scale and write that which an employee is willing and demonstrates Vnum to measure their progress. ____________________________________________________________________ 89-80ber in the corresponding Points box. Points will be totaled and averaged for an overall performance score. ____________________________________________________________________the ability to cooperate, work and communicateG 79-70with coworkers, supervisors, subordinates I Definitions of Performance Ratings ____________________________________________________________________69-60 ____________________________________________________________________and/or outside contacts.UOO IImprovement NeededPerformance is deficient in certain Below 60utstandingPerformance is exceptional in all areas andSubmitted By __________________ Title ____________________ Date _____________is recognizable as being far superior to others. areas. Improvement is necessary. Submitted By __________________ Title ____________________ Date _____________11. JudgmentThe extent to which an employeeOVV UUnsatisfactoryResults are generally unacceptable andUses a simple 100-point rating scale withApproved By ___________________ Title ____________________ Date _____________ 100-90er y GooPdointsResults clearly exceed most position require immediate improvement. No merit increase should beApproved By ___________________ Title ____________________ Date _____________demonstrates proper judgment and decision-V re89-80quirements. Performance is of high quality and is achievedmaking skills when necessary.Gon a co granted to individuals with this rating. stitute for legal advice and does not provide legal opinions on any specific 79-70nsistent basis. I69-60oodCompetent and dependable performance. MeetsN/ANot Applicable or too soon to rate. comment areas to explain the ratings This product is designed to provide accurate a wndit hau ths ep ruondduecrts. tYaondui anrgetuhragte adn tyopceornssounlt an at f h r g orney concerning your particular situation and any specific questions or concerns faacmtsa ogre sse arrvisiciensg.oTuhte o ifn tfhoer musaet ioorn i nisa pbriolivtyid teod use thi thoritative information. However,iotr i se nntoitt yaisnuvbosltvietudt ien f ocrr elaegtianl ga,d pvriocdeu acnind gd oore sd nisottr ipbruotvinidgetlheigsa pl roopdinuicot nissnoont a lniayb slep feocirf aicn yGG d This product is designed to prtoivoind iesapcrcouvriadteod u wsei tthh theorintadteirvset ainnfdoirnmg ation. Hyo pweervseornl to arn e nattorneydaacmts aogre sse arrviisciensg.oTuhte o ifn tfhoer musae or inability t e and au tis p uoduct. You aretuhrate adn to consu , it is noitt yaisnuvbo clvoendc einrn cinrega tyionugr,pparordtiuccuilnargsoitru daitsitornib auntidn agn tyh issp percoifdicu cqtu iess ntiootn lsi aobrl ec ofonrc earnnys U t Blow 60ymI you may have.hee performance standards of the job. oup omratya nhta nvoe.te: This is approved for use by the purchaser only. This form may not be shared publicly or with third parties.Important note: This is approved for use by the purchaser only. This form may not be shared publicly or with third parties.Rate employees overall performance in comparison to position duties and responsibilities.Outstanding100 - 90A22101763 ComplyRight, Inc. Two easy ways to reorder: hrdirect.com800-999-9111 Performance FactorsVery GoodRatingScalePoints Supportive Details or Comments Includes a ComplyRight guide to help A22011763 ComplyRight, Inc. Two easy ways to reorder: hrdirect.com800-999-911189 - 801.hicGoh aodn employeesO 79 - 70100-90,QualityThe extent to w Total PointsNumber of Factors Rated= O te, thorough aImnpd nroevaemt. ent Needed V89-80 Steves performanceCompactwvoerrk ialls acc Ratinurag 69 - 60UnsatisfactoryGBelow 6079-70 improves with each you correctly conduct effective Complete all of the following sectionsI69-60 85 project he works on.UBelow 60 ComplyRight 1. Accomplishments or new abilities demonstrated since last revi2.ew____________________________________________________ Points employee evaluations DescriptionItem #PriceProductivityThe extent to which an O100-90Payroll Forms____________________________________________________________________________________________________________ 89-80employee produces a significant volumeV 2. Specific areas of needed improvement __________________________________________________________________________ 79-70 Payroll/Status Change Noticeof work efficiently in a specified periodG of time.I69-60____________________________________________________________________________________________________________3. UBelow 60 Item #Price Document all job and salary changes, including reclassification,3-Part CarbonlessDL1-A2168$82.49Recommendations for professional development (seminars, tr3.ai ningJob K, schnooowlilngedge, etc.)Th ____________________________________ Pointse extent to which O100-90 ____________________________________________________________________________________________________________ 89-80an employee possesses the practical/technicalV 4. Absences: Number of incidents ________________________________________knowledge requir eNumn tbher oe jof db. ays ________________________G79-70 DL1-A2192 $49.49 transfers and promotions. List new hire information, leave ofStandard FormDL1-A2172$49.49d o I69-60Employees Comments* ____________________________________________________________________________________ UBelow 60____________________________________________________________________________________________________________ Points Price per pkg/50. Size: 8" x 11" absence and separation data. Ensure employee files have DownloadableDL1-A2172DL$32.99*If necessary, additional sheets may be attached. 4.ReliabilityThe extent to which an O100-90 employee can be relied upon regarding* V89-80Discussed with individual on_______________Employees Signtatsurk coe mpletion and follow-up.G79-70 updated, current payroll records. Payroll Change Notice/ / _____________________________________________YesNo *I acknowledge that this Performance Appraisal was discussed with me. I69-60/ /Below 60Follow-up requested/desired Follow-Up Date_________________UEvaluators Signature ________________________________________________________________5.Date_________________ 100-90Points Standard, 3-Part Carbonless DL1-A2170 $82.49/ /AttendanceThe extent to which anO Thhiesipnrfoodrmucatt iios nd eiss ipgrnoevdi dtoed p wroivthid teh ea cucnudraetres taanndd ianugt hthoartit aantiyv ep ienrfsoornm oart ieonnt.i tHy oinwve employee is punctual, observes prescribed e t a a Vervices.89-80 Carbonless form instantly provides copies forT wor i k bre su k/mea rlo gal eriodand do nd has anal opinions on any specific facts or she use79-70o vlev r,d iscnroet ta i n a bfiong l padvice q s, a es not provide leg Gi g, pstriotudtuec er distributing this product is not liable for any damages arising out of t2016 ComplyRight, Inc. omIrnainyg n yo o n t u a la ble overa ll at p tend s ance rec cor erns you may have. I69-60 Compact, 3-Part CarbonlessDL1-A2173$70.49t ubre p sahratriecd pubr ipnoarbtialnittyntoo teu:s Te hthisi si sp aropproved for use bduct. You are urgye tdh teo p cuorncshualste ar no natltyo. rTnheiyscfoonrmcem accep r siltiuclayt i o ornw aintdh th niyr dspea critfiiec . uestions oronc d. A2192 Two easy ways to reorder: hrdirect.com800-999-9111UBelow 60 the employee, supervisor and HRs personnel files6.IndependenceThe extent to which an O100-90Points Price per pkg/50. Standard: 8" x 11", Compact: 5" x 8"employee performs work with little or V89-80no supervision.G79-70 Includes a ComplyRight guide to help you document I69-60 UBelow 60 job and salary changes the right way Downloadable 24 WORKPLACE MANAGEMENTPAYROLL & PERFORMANCE HRDIRECT.COM800.999.9111 25'