b'Implement Company Policies with Ease Record and Communicate Payroll Changes$ 90 ComplyRightSeparation NoticeEmployee InformationSeparation Notice Name ______________________________________________________________________________________________________ Employee/Payroll ID # ______________________A YEAR Position _____________________________________________________________________________ Department_____________________________________________________ PER APP Satisfy the documentation needed when an Supervisor_______________________________________________________________________________________________________________________________________________________________________________/ / / / / /employee resigns, is terminated or laid off, Hire Date_________________________ Last Date Worked_________________________ Effective Separation Date _____________________Details of Separationor retires. Fill-and-SaveTM format simplifies Type of Separation: Resignation Layoff Termination Job abandonmentthe process of routing, completing andOther___________________________________________________________________________________________________________________________________Reason for Separation:storing the form.Personal Other Employment Relocation Retirement Conduct Attendance Performance Reduction/Reorganization Other_________________________________________________________________________________________________Checklist details critical discussion points Final Pay:Yes NoAmount$_____________________________________________Regular Pay Accrued Vacation Pay Yes NoAmount$_____________________________________________Ideal for both on-site and remote workers Accrued Sick Pay Yes NoAmount$_____________________________________________Other Yes NoAmount$_____________________________________________/ /Item # Price Date Payable _____________________ Total Payable Amount$_____________________________________________Separation Meeting:LD1-A0373CFL$27.95 Was there a separation meeting? Yes NoMeeting Date ____________________ Location ______________________________________/ /Attended by____________________________________________________________________________________________________________________________________Administrative Checklist Company Materials/Equipment Returned Facility/Systems Access Terminated Insurance Companies Notified:Company Policies Smart App Fill-and-Save itemEmployee Records ArchivedFinal Pay Processed HealthMajor Medical & Medical COBRA Notification Processed 401(k) 403(b) Option Processed Life Life Insurance Conversion Payroll Adjustment Forms Processed DentalAccess 100+ mandatory, recommended and optional policies including specifics Mail/Pickup Last Paycheck Other ________________________________________for your state. Choose the attorney-approved policies you want to implement,Item #PriceOther ________________________________________/ /edit as needed to fit your companys culture, and create a policy handbookCompleted by ________________________________________________________________________________________________ Date ___________________________LD1-SA900$90 per yearwith ease. Issue policies to individuals or the entire staff and, with automated This product is designed to provide accurate and authoritative information. 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Yt onuo te: This is approved for usetracking, see at a glance when employees have viewed each policy.ImWeb BasedPayroll/Status Change NoticeLearn more at hrdirect.com/smartapps Employee InformationEffective Date of Change__________________________ Available in/ /Name________________________________________________________________________________Employee/Payroll # ______________________________Status: Full-Time Part-Time Full-Time Temporary Part-Time TemporaryFill-and-SavePosition _______________________________________________ Salary Hourly Department_____________________________________ Other___________________________Change(s) for Current Employee format or as part of the ComplyRightTypeFromTime & AttendanceAddress ChangePayroll/Status Change Notice To Payroll Forms ___________________________________________________________________________________________________________Payroll/Status Change NoticeChange of Insurance ___________________________________________________________________________________________________________ DemotionPlease PrintPayroll___________________Form Library ___________________________________________________________________________________________________________Routing___________________HR Policies LibraryDepartment ___________________________________________________________________________________________________________Separation Document all job and salary changes, including Please PrintNEWEnd of Introductory Period ___________________________________________________________________________________________________________ MiddleSeparationRouting Payroll//______________________________________ FLSA ReclassificationEffective Date of Change _____________New Hire on page 11. Change ___________________________________________________________________________________________________________Employee Name_____________________________________________________________________________________________Effective Date of ChangeLast// First New Hire Change_____________ Insurance Eligibility ___________________________________________________________________________________________________________ Job Title ___________________________________________________________________________________________________________ Middle reclassification, transfers and promotions. List newSocial Security # _____________________________ Employee/Payroll # ____________Dept. _____________________________Employee Name_____________________________________________________________________________________________Subscribe to a library of HR policies developed and maintainedLength of Service Increase ___________________________________________________________________________________________________________LastFirst Social Security # _____________________________Employee/Payroll # ____________Dept. _____________________________ Merit Increase ___________________________________________________________________________________________________________Address____________________________________________________________________________________________________ Promotion ___________________________________________________________________________________________________________ StateZIP Code hire information, leave of absence and separationStreetCity by a team of HR experts and labor law attorneys. Select your state Salary/Wage ___________________________________________________________________________________________________________ Other______________________ Telephone #_______________________________ Date of Birth (for administrative use only) __________________/ / ZIP Code() StreetCityState Address____________________________________________________________________________________________________ Shift ChangeStatus:Full-TimePart-TimeFull-Time Temporary Date of Birth (for administrative use only) __________________/ /Telephone #_______________________________ Part-Time Temporary () ___________________________________________________________________________________________________________ Transfer ___________________________________________________________________________________________________________ Other______________________data. Ensure employee files have updated, current Part-Time TemporaryHourly Job Title _______________________________ Exempt Non-ExemptW-4 Attached? Yes Noand get 12 months of unlimited access to a collection of required Union ScaleStatus:Full-TimePart-TimeFull-Time TemporaryHourlyW-4 Attached? Yes No ___________________________________________________________________________________________________________Job Title _______________________________Other _________________________ Change(s) for Current EmployeeExempt Non-Exempt ___________________________________________________________________________________________________________ Change(s) for Current Employee FromToComments payroll records.Type and recommended policies (minimum of 50 state-specific policies). Comments____________________________________________________________________________________________________________________________________ CommentsAddress Change _____________________________________________________________________________________________TypeFromToemotion _____________________________________________________________________________________________D Address Change ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Department ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Choose the policies you opt to use and hide the ones you dont.DemotionContribution _____________________________________________________________________________________________FLSA epartment _____________________________________________________________________________________________ D Reclassification _____________________________________________________________________________________________ Leave of Absence 401(k)/403(b) _____________________________________________________________________________________________ Carbonless form instantly provides copies for FLSA Reclassification _____________________________________________________________________________________________ Insurance Eligibility // // _____________________________________________________________________________________________Begin Leave______________________Return from Leave______________________Job Title _____________________________________________________________________________________________401(k)/403(b) ContributionPolicies can be routed electronically, printed or cut and pastedEducationalInsurance Eligibility _____________________________________________________________________________________________Personal Family/Medical Leave (including Pregnancy)Short-Term DisabilityJob Title _____________________________________________________________________________________________ the employee, supervisor and HRs personnel filesChange of Insurance _____________________________________________________________________________________________Long-Term Disability Other_______________________________________offof Insurance _____________________________________________________________________________________________Lay Change _____________________________________________________________________________________________into an existing handbook.SeparationSeparation Date ______________________ _____________________________________________________________________________________________Layoff // //// Last Day Worked______________________Last Day Paid________________________Length of Service Increase _____________________________________________________________________________________________Involuntary Separation_____________________________________________________________________________________________ Voluntary Separation erit Increase//M Length of Service Increase _____________________________________________________________________________________________Election of COBRA YesNond of Introductory PeriodNotice of COBRA Rights Provided on_________________________ Includes a ComplyRight guide to help you E Merit Increase_____________________________________________________________________________________________//_____________________________________________________________________________________________Start Date of Coverage______________________End of Introductory Period _____________________________________________________________________________________________Promotion _____________________________________________________________________________________________If yes, describe type of coverage elected:_________________________________________________________________________________________________eevaluation of Current Job _____________________________________________________________________________________________R Promotion _____________________________________________________________________________________________Categories cover a wide range of subjects from benefits Authorizations Reevaluation of Current Job_____________________________________________________________________________________________ document job and salary changes the right way_____________________________________________________________________________________________Rehire _____________________________________________________________________________________________esignation _____________________________________________________________________________________________R Rehire _____________________________________________________________________________________________Employee Signature (optional)______________________________________________________________________________//Date_____________________R Resignation _____________________________________________________________________________________________etirement _____________________________________________________________________________________________and compliance to conduct, safety and company propertySupervisor/Manager Signature_____________________________________________________________________________ Date_____________________alary/Wage _____________________________________________________________________________________________S Retirement _____________________________________________________________________________________________Salary/Wage //Separation __________________________________________________________________________________________________________________________________________________________________________________________Human Resources/Payroll Manager Signature_____________________________________________________________ Date_____________________ DescriptionItem #PriceSeparation //Shift Change __________________________________________________________________________________________________________________________________________________________________________________________T Shift Change _____________________________________________________________________________________________ ransfer _____________________________________________________________________________________________ Policies are Microsoft Word documents that can benion Scale _____________________________________________________________________________________________ U Transfer _____________________________________________________________________________________________Routing:Union Scale Begin Leave _____________________________________________________________________________________________ Payroll/Status Change NoticeOther ______________ Payroll ____________________________________________________ ____________________________________________________ Other ______________Leave of Absence / / / /personalized for your companyEducational ______________ Return from Leave________________Family/Medical Leave (Including Pregnancy)Leave of Absence Begin Leave______________ Return from Leave________________/ / / /pShort-Term Disability Personal Other ______________________________ 3-Part CarbonlessLD1-A2168$92.95This product is designed to provide accurate and authoritative information p. rHooviwdeevde wr, iitth i st heFamily/Medical Leave(Including Pregnancy) EducationalLong-Term DisabilityPersonal no tu an dsuebrssttaitnudtein fgo trh laetg aaln ayd pveicreso ann 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Yt onuo ater:e T uhrigs eisd a tpop croonvseudl tf oarnuasteto bryn ethy ec opnucrecrhnaisnegryoonulyr .p Tahritsi cfourlamrmay not be shared publicly or with third parties. / / Last Day Paid _______________ Standard FormLD1-A2172$56.95A Im Separation Separation Date _________________ Last Day Worked _________________ Last Day Paid/ // /Separation Separation Date/ / / /Notice of COBRA Rights Provided on_____________/ / Involuntary Separation/ / Voluntary Separation_________________ Last Day Worked _________________ _______________ Voluntary SeparationInvoluntary SeparationNotice of COBRA Rights Provided on_____________/ /Election of COBRA YesNo Start Date of Coverage_______________/ /Election of COBRA YesNo Start Date of Coverage_______________/ /If yes, describe type of coverage elected:_____________________________________________________________________________ Fill-and-Save Format*LD1-A2172CFL$27.95Unlimited 24/7 web access for multiple users If yes, describe type of coverage elected: _____________________________________________________________________________Fill-and-Save Additional Comments ________________________________________________________________________________________________Additional Comments ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Price per pkg/50. Standard: 8" x 11".Guaranteed compliancepolicies are updated Employee Signature(Optional)_________________________________________________________________________Date ________________Name and Title / /Employee Signature(Optional)_________________________________________________________________________Date ________________ *Fill-and-Save form varies slightly from paper version.Name and Title / /Name and Title / /Supervisor/Designated Manager Signature_____________________________________________________________ Date ________________should federal or state requirements changeSupervisor/Designated Manager Signature_____________________________________________________________Date ________________Name and Title / // /Human Resources/Payroll Manager Signature ___________________________________________________________ Date ________________Name and Title / /Human Resources/Payroll Manager Signature ___________________________________________________________Date ________________Name and TitleTrh sies rpvriocdesu.c Tt hise d iensfiogrnmeadt tioon p riso vpirdoev aidcecdu rwatiteh a tnhdeauuntdheorrsittaantidvein ign ftohramt aantiyo pne. rHsoonw eovre ern, itti tiysninovto alv seudb sinti tcuretea tfoinrg l,e pgarol daduvciicnegaonrd d disotreisb nuotitn pgr othviids ep rloegdaulc ot piis nnioont lsi aobnl ea nfoyr s apneyc idfiacm faacgtessoamI Thise rpvriocdeus.c Tt hisediensfiogrnmeadt itoo np riso vpr toov iudseed t hwiist hp rtohdeu ucnt.d Yeorsut aanrde iunrgg etdh atto a cnoyn psuerlst oannoatrt eonrney concerning your particular situation and an t provide legal opiisn nioont lsi ao n any speyc idfaicm faacgtessve.Fill-and-Save itemo ide accurate and authoritative information. However, itti tiysninovto alv seudb sinti tcuretea tfoinrg l,e gpraol daudcviicnegaonrd d disoterisb nuotiyn gs ptehciisf ipcr oqduuesctti ons or c obnlcee fronrs a ynou may harispionrgt aonuttnoof tteh:e T uhsiesiosrainppabroilvietydtfoo ru uses et hbiystphreo dpuurcct.h Yasoeuraornel uy.r Tgehdi st ofo cromn smualty a nno at tbtoe rsnheayr ecdo npcuebrlnicinlygoyro wuri tpha trhtiicrdu lpaar tion and any specific questions or concerns you may have.r stiiteusa.22011668 ComplyRight, Inc. arr issionrgt aonuttnoof tteh:e T uhsiesiosraipnparboilvietyd for use by the purchaser only. This form may not be shared publicly or with third parties.Item # Price per State A 22101668 ComplyRight, Inc. Two easy ways to reorder: hrdirect.com800-999-9111ImpA Two easy ways to reorder: hrdirect.com800-999-9111LD1-A9050W$99 per year 3-Part Carbonless20 WORKPLACE MANAGEMENTPOLICIES & PAYROLL HRDIRECT.COM800.999.9111 21Downloadable'