Last Name: First Name:

Current Department /Cost Center Employee ID #:

Name Change Cambio de nombre

You will need to provide government documents confirming the name change

Address Change Cambio de direccion

Street Address / Direccion Apt # City / Ciudad State/Estado Zip Code / Codigo Postal

Contact Number(s) Numero Telefonico

Home / Casa

Mobile / Celular

Home / Casa

Mobile / Celular

Only complete the fields you are requesting to update/change.

PERSONAL INFORMATION (completed by employee)

Emergency Contact Contacto de Emergencia Name / Nombre Contact # / Numero Telefonico

Relationship / Relacin Parent / Padres

Sibling / Hermano(a) Child / Hijo(a)

Other / Otros

Spouse/ Domestic Partner Cnyuge / Pareja Domstica

POSITION MANAGEMENT

Employment Status:

Position Title:

Reports To/Manager:

FROM TO

Department/ Cost Center [LL5]:

Work Center [LL6]:

Only complete the fields you are requesting to update/change.

Status Change Promotion Transfer Demotion Accommodation Other:Reason for Change:

Effective Date:

Employee Action Form (EAF)Please complete electronically for

full form functionality & then print!

Total Pay Rate*:

* Total Pay Rate is Base Rate + Factors **Confirm with Payroll if employee already has Process Expert or Leader pay included in Total Pay Rate. Max rate for Team Leader is $2.50, this includes any previous leader/expert pay

COMPENSATION MANAGEMENT

Other:DemotionTransferPromotionReason for Change: Merit Increase

Per Hour

Per Year

Per Hour

Per Year

Process Expert [$0.50]** Plant Only

Team Leader [$2.50]** Plant Only

Lead Pay [$1.00] Transportation Only

Mentor Pay [$1.00] Transportation Only

Select Factors Calculated in Total Pay Rate*Select Factors Calculated in Total Pay Rate*Mentor Pay [$1.00] Transportation Only

Lead Pay [$1.00] Transportation Only

Team Leader [$2.50]** Plant Only

Process Expert [$0.50]** Plant Only

Effective Date:

Pay Grade Change: (salaried employees only)

FROM TO

Current:

Grade # - Grade Description

New:

Grade # - Grade Description

APPROVAL / CONFIRMATION

For all changes excluding personal information, two levels of approvals are needed. Forms missing approval will not be processed.

HUMAN RESOURCES / PAYROLL USE ONLY

Personal Data Change Checklist

Changed in Kronos

Notify Payroll if address change is outside of 5 Boroughs or out of State

Changed in 401k

I-9 Updated (if name change)

Processed By:

Processed Date:

Position / Salary / Labor Level Change(s) Checklist

Change Processed in Kronos

Retroactive Pay Issued?Yes

No

Processed Date:

Processed By:

Separation of Employment Checklist

PTO Paid Out? Yes No

Processed Date:

Processed By:

# of Days:

Processed in Kronos

TALX Data Entered

If Exempt EE, Payroll notified of stop payment

Personal & Medical file pulled for scanning

I-9 Relocated to Inactive Binder for Company

Severance Agreement Attached (if applicable)

SUBMIT COMPLETED FORMS TO HUMAN RESOURCES

Employee Action Form (EAF)

Print Name Signature Date Approver

Employee Signature

Current Department Manager [ Not required for Personal Information]

New Department Manager [ Required for Transfer Only ]

Senior Department Manager [ Transfer /Salary Increase Only ]

Talent Acquisition Manager [ Transfer /Salary Increase Only ]

HR Business Partner [ Required for Termination Only ]

Last day employee physically worked:

Reason for Separation:

Separation Type:

Separation Effective Date:

# of Days*

Only if: Resignation 2Wks Notice, Retirement or approved by SVP of Human Resources. Max = 10 Days / 80 HRS

Severance Agreement?Please Attach Agreement

Eligible For PTO pay out

Checklist

Company Assets Collected (if applicable):

ID Card Smart Phone / Nextel

Laptop Parking Lot Pass/Key

Desk Keys

SEPARATION OF EMPLOYMENT

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