b'HIRING & ONBOARDINGDIGITAL SOLUTIONS PAYROLLPAPER & DIGITAL SOLUTIONSSeparation NoticeEmployee InformationSeparation Notice Name ______________________________________________________________________________________________________ Employee/Payroll ID # ______________________Position _____________________________________________________________________________ Department_____________________________________________________ Satisfy the documentation needed when anSupervisor_______________________________________________________________________________________________________________________________________________________________________________/ / / / / /Hire Date_________________________ Last Date Worked_________________________ Effective Separation Date _____________________employee resigns, is terminated or laid off, orDetails of SeparationType of Separation:retires. Fill-and-Save format simpli es the ResignationLayoffTerminationJob abandonment Other___________________________________________________________________________________________________________________________________process of routing, completing and storingReason for Separation:the form.PersonalOther EmploymentRelocationRetirementConductAttendancePerformance Reduction/ReorganizationOther_________________________________________________________________________________________________Final Pay:Item # Price Regular Pay Yes NoAmount$_____________________________________________Accrued Vacation Pay Yes NoAmount$_____________________________________________A0373CFL$28.95 Accrued Sick Pay Yes NoAmount$_____________________________________________Other Yes NoAmount$_____________________________________________/ /Date Payable _____________________ Total Payable Amount$_____________________________________________Fill-and-Save item Separation Meeting:/ /Was there a separation meeting?YesNoMeeting Date ____________________ Location ______________________________________Attended by____________________________________________________________________________________________________________________________________Administrative ChecklistCompany Materials/Equipment ReturnedFacility/Systems Access TerminatedInsurance Companies Notified:Employee Records ArchivedFinal Pay Processed HealthMajor Medical & MedicalCompany Policies Smart App COBRA Notification Processed401(k) 403(b) Option Processed LifeItem #Price Life Insurance ConversionPayroll Adjustment Forms Processed DentalMail/Pickup Last PaycheckOther ________________________________________Access 100+ mandatory, recommended and optional policiesSA900$129 per year Other ________________________________________including speci cs for your state. Choose the attorney-approvedCompleted by ________________________________________________________________________________________________ Date ___________________________/ /policies you want to implement, edit as needed tot your companysWeb Based This product is designed to provide accurate and authoritative information. However, ith i st hneo tu an dseurbssttaitnudtien gfo trh laetg aanl ayd pveicreso ann od rd eonetsi tny ot provided l eing acrl eoaptiinnigo,n psr oond uacniyn gs poerc difisict rfaibcutsti nogrstheirsv picreosd. uTchte i sin nfoort mliaabtiloe nf oisrapnroyv didaemda wgeits a anryis sinpge coiufictoqfu tehset iuosnesoorricnoanbcileitryn sto y ouuse m thaiyshave.culture, and create a policy handbook with ease. Issue policies to02307232 CCFoLmplyRight, Inc. inrvop odortA Im lv uecat.n Yt onuo ater:e T uhrigs eisdatop pcroonvseudl tf oanruasteto bryn ethy ec opnucrechrnaisnegryoonulyr . pTahritsi cfoulramrsmitauya tnioontbaen dshared publicly or with third parties.pindividuals or the entire staff and, with automated tracking, see at a glance when employees have viewed each policy.Learn more at hrdirect.com/smartappsPayroll/Status Change NoticeEmployee Information Available in / /Effective Date of Change __________________________Name ________________________________________________________________________________Employee/Payroll # Fill-and-Save______________________________Position_______________________________________________Salary HourlyDepartment _____________________________________Status:Full-TimePart-TimeFull-Time TemporaryPart-Time Temporaryformat or as part of the Other ___________________________Change(s) for Current Employee Time & Attendance Type Payroll/Status Change Notice To Form LibraryFromAddress Change ___________________________________________________________________________________________________________ Change of Insurance ___________________________________________________________________________________________________________ Payroll Forms Demotion Please PrintPayroll___________________ on page 39.___________________________________________________________________________________________________________ Department Routing ______________________________________________________________________________________________________________________________// End of Introductory Period Effective Date of Change _____________ New Hire Change Separation___________________________________________________________________________________________________________ FLSA Reclassification ___________________________________________________________________________________________________________ Middle Document all job and salary changes, Employee Name _____________________________________________________________________________________________HR Policies LibraryInsurance Eligibility ___________________________________________________________________________________________________________ _____________________________Last First Job Title Social Security #_____________________________ Employee/Payroll #____________Dept.___________________________________________________________________________________________________________ Length of Service Increase ___________________________________________________________________________________________________________ including reclassi cation, transfers andMerit Increase Address _______________________________________________________________________________________________________________________________________________________________________________________________________________Subscribe to a library of HR policies developed and Promotion ___________________________________________________________________________________________________________ State / / ZIP CodeStreet City Salary/Wage Telephone # _______________________________ Date of Birth (for administrative use only)__________________ promotions. List new hire information, leave ()___________________________________________________________________________________________________________ Shift Change Status: Full-Time Part-Time Full-Time Temporary Part-Time Temporary Other_________________________________________________________________________________________________________________________________maintained by a team of HR experts and labor lawTransfer Job Title_______________________________ Exempt Non-Exempt Hourly W-4 Attached?YesNo___________________________________________________________________________________________________________ Union Scale ___________________________________________________________________________________________________________ of absence and separation data. Ensure Other_________________________ Change(s) for Current Employee___________________________________________________________________________________________________________Type From To Commentsattorneys. Select your state and get 12 months ofComments____________________________________________________________________________________________________________________________________ Address Change _____________________________________________________________________________________________ employeeles have updated, current payroll Demotion ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Department _____________________________________________________________________________________________unlimited access to a collection of required and_________________________________________________________________________________________________________________________________________________FLSA Reclassification _____________________________________________________________________________________________ records. Includes a ComplyRight guide to 401(k)/403(b) Contribution _____________________________________________________________________________________________ // ______________________ // Leave of Absence Begin Leave Insurance Eligibility Return from Leave ______________________recommended policies (minimum of 50 state-speci c EducationalJob TitleInsurance _____________________________________________________________________________________________ Short-Term DisabilityPersonal _____________________________________________________________________________________________ help you document job and salary changesFamily/Medical Leave (including Pregnancy) Change of _____________________________________________________________________________________________Long-Term DisabilityOther _______________________________________ Layoff _____________________________________________________________________________________________ policies). Policies are Microsoft Word documents Separation Separation Date ______________________Last Day Worked ______________________Last Day Paid ________________________ Voluntary SeparationLength of Service Increase _____________________________________________________________________________________________ the right way.// // //// Merit Increase _____________________________________________________________________________________________Involuntary SeparationNotice of COBRA Rights Provided on _________________________Election of COBRA YesNoEnd of Introductory Period ______________________ Promotion //Start Date of Coverage_____________________________________________________________________________________________that can be personalized for your company and canIf yes, describe type of coverage elected:______________________________________________________________________________________________________________________________________________________________________________________________ Reevaluation of Current Job _____________________________________________________________________________________________ AuthorizationsRehire _____________________________________________________________________________________________ be routed electronically, printed or cut and pastedEmployee Signature (optional)Resignation _____________________________________________________________________________________________ DescriptionItem #Price //______________________________________________________________________________Date _____________________ Retirement _____________________________________________________________________________________________Salary/Wage //Retirement _____________________________________________________________________________________________Supervisor/Manager Signature _____________________________________________________________________________ Date _____________________into an existing handbook. Policies are updatedSeparation _____________________________________________________________________________________________ Payroll/Status Change NoticeS//Human Resources/Payroll Manager Signature_____________________________________________________________________________________________ Shift Change_____________________________________________________________ Date _____________________ Transfer _____________________________________________________________________________________________should federal or state requirements change. Union Scale _____________________________________________________________________________________________ 3-Part Carbonless A2168$94.95 Other______________Routing:Payroll ____________________________________________________ ____________________________________________________Leave of Absence Begin Leave ______________ Return from Leave ________________/ / / / EducationalPersonalFamily/Medical Leave(Including Pregnancy) Standard Form A2172$58.95inrvoovlivdeedl eing acrlrl eShort-Term DisabilityLong-Term Disability OtherThis product ioaptiinnigo,n psr ooodnd uacninyn gs poerc distributing this product is not liable i tion. However, it is not a substitudtein n ugs eth oartaiainnayb pilieietyryrs toon u osreethnhntis ______________________________p s designed to provideif iacc fcaucrtast eo ra nsedr aviuctehso. rTrTihtaet iivnef oinrmfoartmtioan f oisr apnroy v didaemda wgeitshatrhisei nugn ododueurts s otfa nthe e for legal advice and doesit t ny ot Item # Price per State A22107222C CFoLmplyRight, Inc.Separation Date Last Day Worked Last Day Paidd_____________ Fill-and-Save Format* A2172CFL$28.95 p Separation _________________ _________________ _______________Imropdourtctcatn.n. Yt onuo tater:e T uhrisg eisd a atopopp p croonvseudl tf oarnrnuasteto brnyny ethy ec opnucrechrhrnaisnegryoonulyr. . p pTahritsi cfouourlramrsmitauya tnioontbaen dsh aanrye dsp peucbifliicc lqyu uoers s wtiioithnhn st hoirr dc opnacretirenss. / // /you may have. / /Voluntary Separation Involuntary Separation Notice of COBRAAA Rights Provided on/ // /Election of COBRA YesNo Start Date of Coverage _______________ A9050W$99 per year If yes, describe type of coverage elected: _____________________________________________________________________________ Price per pkg/50. Standard: 8" x 11". _____________________________________________________________________________Additional Comments ________________________________________________________________________________________________ *Fill-and-Save form varies slightly from paper version.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Name and Title / /Employee Signature(Optional) _________________________________________________________________________ Date________________/ /________________Name and Title / /Supervisor/Designated Manager Signature _____________________________________________________________ Date________________Human Resources/Payroll Manager Signature___________________________________________________________ Date________________ Fill-and-Save item/ // /Name and Title Date________________/ /Date________________T T urate and authoritative information. 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Hrsoown eovre ern, itti tiysninovto al vseudb sinti tcuretea tfoinr gl,e pgraol daudvciicnegaonrd d idsoterisb nuotitn pgr othviids ep rleogdaulc ot pisi nniootn lsi aobnl ea nfoyr s apneyc idfaicm faacgtess your particular situation and any specific questiarispsionrgt aonuttnoof tteh:e T uhsiesoiosraipnpabrboilvietydtfoo ru uses et hbiystphreo dpduucrtc.h Yaoseuraornel yuy.r TgTehdi st ofo cromn smualaty a nno att tbtoe r snheayr ecdo npcuebrlnicinlyg or with third parties. amI arising 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.2222012628 ComplyRight, Inc. Two easy ways to reorder: hrdirect.com800-999-9111AA44 WORKPLACE MANAGEMENTPOLICIES & PAYROLL HRDIRECT.COM800.999.9111 45'