Payroll Update Form

Your Name *

First Name

Last Name

Effective Date for Change *

MM

DD

YYYY

Acknowledgment *

I understand and agree that payroll update forms submitted with less than two weeks' advance notice may result in the changes not being made effective prior to the next issuance of payroll. I further understand and agree that the change has not been made simply by submitting this form; I understand that the payroll update changes requested in this form are not made effective until I receive a response in writing from management, and I also understand that it is my responsibility to follow up with management if this confirmation has not been received in a timely fashion.

Yes, I understand and agree