Store: Choose an item.	Effective Date: Click here to enter a date.

Type of Change: Choose an item. Employee#:

Reason: Choose an item.

Comments: First Name:

Last Name:

Address: City: State

ZIP:

Phone:

Sex: Choose an item. Date Of Birth: Click here to enter a date.

Start Date: Click here to enter a date. Pay Type: Choose an item.

Employee Status: Choose an item..

Married? :Choose an item.	# Of Dependents:

Department:Choose an item.	Job: Choose an item.

Hourly Rate: $ /Hr.	Shirt Size: Choose an item.

Approving GM:

Date Approved:Click here to enter a date.