Status Change Form
Status Change Form
Employee ID:
NAME (FIRST & LAST): EFFECTIVE DATE (mm-dd-YY):
PERSONAL INFORMATION UPDATE (NO Approval Required) - Please check off the items that you wish to update
☐Address Update ☐Contact Number
Address 1 New Phone #
Address 2 ☐Work Authorization: SIN/SSN/NRIC Update *Attach
Proper Supporting doc.
City, Status: ☐PR ☐Citizen ☐Work Permit
Province/State
Postal/Zip Code ☐Bank info *Attach Direct Deposit form or Void Cheque
Country Institution #
☐Contact Email Transit #
New Email Account #
EMERGENCY CONTACT UPDATE (NO Approval Required) – NEW EMERGENCY CONTACT
Name Relationship
Contact Number Contact Email
Address
DATE Comment
Employee Signature (Month Day Year)
DATE Comment
Manager Approval (Month Day Year)
DATE Comment
HR Approval (Month Day Year)
Comment
CEO / Executive Approval (Month Day Year)