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 Printayroll______________________________________Charlie Schuster12541AccountingPRoutingwith multiple occurrences. Distribute written warningRouting 68 16 New Hire Change Separation_____________ ___________________Effective Date ofPayroll//Change ___________________ 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-Time TemporaryDate of Birth (for administrative use only) __________________ Date _____________________ I.D. # ___________________ Social Security # ____________________________ Telephone #_______________________________ Part-Time TemporaryOther ______________________Full-TimePart-Time/ /()Save time with duplicate warning slips Name _______________________________ Title ___________________________ Classification ___________________ Job Title _______________________________Exempt Non-Exempt Hourly Other ______________________ 7-28-187 late daysJanice Lauffer Clerk Level 1 Status: ClerkW-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 ddress Change _____________________________________________________________________________________________City/State/ZIP __________________________________________________Phone () _______________ A TypeFromToCommentsreduce compensation offenders and actions taken Address Change _____________________________________________________________________________________________DemotionCharlie 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 _____________________________________________________________________________________________401(k)/403(b)Contribution _____________________________________________________________________________________________ Enter on Payroll Transfer to:(Department)_______________________________Insurance Eligibility _____________________________________________________________________________________________ Insurance Eligibilityand discipline employees the right wayJob Title _____________________________________________________________________________________________Job Title _____________________________________________________________________________________________ Change Rate Change Shift to: __________________________________________ of Insurance _____________________________________________________________________________________________Change _____________________________________________________________________________________________Changeof Insurance _____________________________________________________________________________________________Layoff off _____________________________________________________________________________________________ Remove from Payroll Change Withholding Rate(complete new W-4 form) Lay _____________________________________________________________________________________________ Length of Service Increase _____________________________________________________________________________________________Length of Service Increase _____________________________________________________________________________________________ Change Title to: ______________________________________ Merit Increase_____________________________________________________________________________________________ FLSA ReclassificationMerit Increase_____________________________________________________________________________________________ Item #Price End of Introductory Period _____________________________________________________________________________________________ E nd of Introductory Period _____________________________________________________________________________________________ Change Status to Full-TimePart-Time Temporary Promotion _____________________________________________________________________________________________ Promotion _____________________________________________________________________________________________PB1-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)________________________________Rehire _____________________________________________________________________________________________ Rehire _____________________________________________________________________________________________ Price per pkg/50. 4-part carbonless. Payroll Change Notice R esignation _____________________________________________________________________________________________ResignationAddress/Information Change ________________________________________________________________etirement _____________________________________________________________________________________________R Retirement __________________________________________________________________________________________________________________________________________________________________________________________Size: 8" x 11"________________________________________________________________ S alary/Wage _____________________________________________________________________________________________Salary/Wage _____________________________________________________________________________________________ Payroll Change Noticeeparation _____________________________________________________________________________________________S Separation _____________________________________________________________________________________________ Date ________________ I.D. # ______________ Social Security # ____________________hift Change _____________________________________________________________________________________________S Shift Change _____________________________________________________________________________________________ Name _______________________ Title ___________________ Classification _____________ _____________________________________________________________________________________________T Transferransfer _____________________________________________________________________________________________ Date EffectiveHournion Scale _____________________________________________________________________________________________ Date ________________ I.D. # ______________ Social Security # ____________________U Union 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 / / / / / // / / / / / Division ___________________ Department ______________Shift __________________ Separation Date _________________ Last Day Worked _________________Last Day Paid_______________ / /Separation Separation Date _________________ Last Day Worked _________________ Last Day Paid_______________Enter on PayrollTransfer to: (Department) _________________________ Involuntary SeparationNotice of COBRA Rights Provided on_____________ Voluntary SeparationCheck appropriate box:Voluntary SeparationInvoluntary SeparationNotice of COBRA Rights Provided on_____________/ /Reason for Payroll Change Change Rate Change Shift to: ___________________________________YesNo Start Date of Coverage_______________/ /Election of COBRAYesNo Start Date of Coverage_______________/ /Election of COBRAEnter on PayrollTransfer to: (Department) ______________________________________________________________________________________________________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 ________________Supervisor/Designated Manager Signature_____________________________________________________________/ / Address/Information Change _______________________________________________Name and Title Date ________________ Leave of Absence: Paid?YesNoReturn (Date of return to work)____________________ Name and Title / /Human Resources/Payroll Manager Signature ___________________________________________________________Date ________________Remarks: __________________________________________________________________________________________ Human Resources/Payr oll Manager Signature ___________________________________________________________Date ___________________________________________________________________________________ Name and Title / / Address/Information Change _______________________________________________ Name and Title _______________________________________________________________________________________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, itti tiysinnovto alv seudb sinti tcurteea tfionrg l,e pgraol daudvciicnegaonrd d disoterisb nuotitn pgr othviisd pe rleogdaulc ot pisin niootn lsi aobnl ea nfoyr s apneyc idfiacm faacgtess General FactorsRatingScaleSupportive Details or Comments Date EffectiveHour orr isseinrvgi oceust.oTf hteh ein ufsoer mora itnioanb iilsi tpyr toov uidseed t hwiist hp rtohdeu ucnt.d Yeorsut aanrde iunrgg etdha tto a cnoyn psuerlts oannoatrt eonrney concerning your particular situation and any specific questions or concerns you may have.a 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 ____________ A A Two easy ways to reorder: hrdirect.com800-999-9111Date EffectiveHour 22011668 ComplyRight, Inc. Two easy ways to reorder: hrdirect.com800-999-9111employee proposes ideas, finds newV89-80_______________________________________________________________________________________Old Rate ______________Per ____________and better ways of doing things.G79-70 New 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 assumesV89-80Please Print Reason for Payroll Changeadditional 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 AppraisalI69-60 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 particularNew Employee UEmployee 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 ID69-60 ployee began present position ___// Date of last appraisal ____//Scheduled appraisal date___// 19 and provide your employees a clear way Standard Remarks: ____________________________________________________________________ Baelote emw 60__________ 315 183 1 7 Remarks: ____________________________________________________________________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 Poinptsloyees 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 consistent basis. granted to individuals with this rating. r v79-70 I69-60 N/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 orney concern leganugre acilnargsoirtu daitsitornib aund any specific questions or concerns 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 provide accurate and authoritative inform athtiaotn a. nHyo pweervseorn,iot ri se nntoitt yaisnuvbosltviteudt ein f ocin l a,d ppaorcu nd does not protvinidge t lheigsa pl roopdinuicot nissnoontalinayb lsep efocirf aicn y faacmtsa ogre sse arrvisiciensg.oTuhte o ifn tfhoer musaet ioorn i nisa pbriolivtyid teod use thi r ega ytio ricdtiuBelow 60oodCompetent and dependable performance. Meetsdaacmtsa ogre sse arrviisciensg.oTuhte o ifn tfhoer musaet ioorn i nisa pbriolivtyid teod u wsei tthh tihs pe ruondduecrts. tYanoud ianrge urged to consult an at U the performance standards of the job. ymI ymI orney concerning your particular situation and any specific questions or concerns oup moratya nhta nvoe.te: This is approved for use by the purchaser only. This form may not be shared publicly or with third parties.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.Rate employees overall performance in comparison to position duties and responsibilities.Outstanding100 - 9022101763 ComplyRight, Inc. Two easy ways to reorder: hrdirect.com800-999-9111A22011763 ComplyRight, Inc. Two easy ways to reorder: hrdirect.com800-999-9111 Performance FactorsVery GoodRatingScalePoints Supportive Details or Comments Includes a ComplyRight guide to help A89 - 801.QualityThe extent to which an employeesGoodO 79 - 70100-90,Total PointsNumber of Factors Rated= O te, thorough aImnpd nroevaemt. ent Needed V 69 - 6089-80 Steves performanceCompactwvoerrk ialls acc Ratinurag UnsatisfactoryGBelow 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 evaluationsProductivityThe extent to which an O100-90Payroll Forms____________________________________________________________________________________________________________ 89-80employee produces a significant volumeV 2. Specific areas of needed improvement __________________________________________________________________________ 79-70of work efficiently in a specified periodG of time.I69-60____________________________________________________________________________________________________________3. UBelow 60 Item#Price Document all job and salary changes, including reclassification, Recommendations for professional development (seminars, tr3.ai ningJob K, schnooowlilngedge, etc.)Th ____________________________________ Pointse extent to which O100-90 ____________________________________________________________________________________________________________ 89-80an employee possesses the practical/technicalV d o DescriptionItem #Price4. Absences: Number of incidents ________________________________________knowledge requir eNumn tbher oe jof db. ays ________________________G79-70 PB1-A2192 $49.49 transfers and promotions. List new hire information, leave of * I69-60Employees Comments ____________________________________________________________________________________ UBelow 60 Payroll/Status Change Notice____________________________________________________________________________________________________________ Points Price per pkg/50. Size: 8" x 11" absence and separation data. Ensure employee files have*If necessary, additional sheets may be attached. 4.ReliabilityThe extent to which an O100-90 employee can be relied upon regarding* V89-80/ / _____________________________________________ 3-Part CarbonlessPB1-A2168$82.49Discussed with individual on_______________Employees Signtatsurk coe mpletion and follow-up.G79-70 updated, current payroll records.YesNo *I acknowledge that this Performance Appraisal was discussed with me. I69-60Follow-up requested/desired / /Below 60Follow-Up Date_________________Uate_________________ Standard FormPB1-A2172$49.49/ /Evaluators Signature ________________________________________________________________5.AttendanceThe extent to whic h anDO100-90PointsThis product is designed to provid teh ae cucnudraetres taanndd ianugt hthoratit aantiyv ep ienrfsoornm oart ieonn employee is punctual, observes prescribed er a e V s ghe use89-80 Carbonless form instantly provides copies for Payroll Change NoticeT wor t in u ra es ak/mea r leogra d l iastd rvibicu et iann gd t hdoi nd h p crt ov inde t lelig aabll eo pfoinr iaonnysdoanm aangye ss paerci ifiinc f aocuttsofrtservices. 79-70t.i tHy oinwveo vlevr,d k b la ubstitute fo l periods, a se ps rn oodtu c as anyou may have. Giis notImportant note: This is approvedm o t ubre p shart icc on ny s cific questions oroncns orh ien ianbfiolirtmy taoti ounse i st hpirso pvriodeddu cwt.i tYho fuo ra ures eu brgye dth teo p cuorncshualste ar no antltyo. rTnheiyscfoornmcernainy gn yo accept reati n sigt,u partoi du acinndgl at p tendance reis r er d o .I o 69-60able overal coA22101962 ComplyRight, Inc. Two easy ways to reorder: hrdirect.com800-999-9111ared publicly or with third parties. UBelow 60 the employee, supervisor and HRs personnel files6.IndependenceThe extent to which an O100-90Points Standard, 3-Part Carbonless PB1-A2170 $82.49employee performs work with little or V89-80no supervision.G79-70 Includes a ComplyRight guide to help you document Compact, 3-Part CarbonlessPB1-A2173$70.49 I69-60 UBelow 60 job and salary changes the right way Price per pkg/50. Standard: 8" x 11", Compact: 5" x 8"24 PERFORMANCE MANAGEMENT HRDIRECT.COM800.999.9111 25'