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FREE 3+ Payroll Change Notice Forms in PDF - Sampleforms

FREE 3+ Payroll Change Notice Forms in PDF - Sampleforms 2025

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The document is an Employee Hourly Rate and Work Status Change Form used to record changes in an employee's hourly pay rate, work hours, job classification, and other employment details. It includes sections for employee information, current and new pay rates, retroactive pay considerations, changes in weekly hours worked, job class codes, organizational details, and supervisor information. The form requires certification from the department head and is intended for use by the Auditor's Office.

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Click ‘Get Form’ to open the Payroll Change Notice Form in the editor.
Begin by filling out the Employee’s General Information section. Enter the Employee Number, Department, Last Name, First Name, Middle Initial, Effective Date, and Effective Check Date.
In the Hourly Pay Rate Change section, input the Current Hourly Pay Rate and New Hourly Pay Rate. Indicate if retro pay is applicable by selecting 'Yes' or 'No'. If 'Yes', ensure to attach supporting documentation.
For Change in Weekly Hours Worked, enter the Old and New Number of Hours Worked Biweekly. Specify the Work Status as either Full-Time or Part-Time.
In the Change in Job section, provide Old and New Job Class Codes along with any relevant Position Numbers. Update Org/Obj/Proj/% codes as necessary.
Complete the Certification section by having the Department Head (or designee) sign and date the form.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (172 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a payroll correction form?

A payroll correction is a payroll run that happens off your regular cycle to fix an error made in a previous payroll. For most payroll mistakes, time is of the essence when it comes to fixing them, which is why employers often opt for correction, or off-cycle, payroll runs in those situations.

What is a payroll adjustment form?

This form should be used to submit payment adjustments for specific types of earnings that require authorization and/or verification by HR- Payroll. Employee Name. Pay Period.

What is an employee change form?

An employee status change form is an official document that records modifications to an employees work circumstances. The changes could be related to their job title, location, salary, department, or transition from part-time to full-time work (or vice versa).

What is a payroll change form?

An employee payroll change form is a document, often used by human resources personnel, which details a change made to an employees pay rate.

What does payroll change mean?

A Payroll Change is any adjustment made to the workers salary or benefits. They can be one-off changes or more permanent, in the form of a contractual change.