PAYROLL CHANGE FORM PAYROLL CHANGE FORM Store InformationStore Location*Queen StCreameryBanffWhistlerNOTLQuebecAvonleaAvonlea Factory OutletCavendishGatewayHalifaxHalifax KioskHalifax Cable WharfNFLPeakesCheeseIce CreamScreenprintWarehouseOfficeAction Type (Form will update accordingly)* Hiring Rehiring Termination Other If OtherPosition ChangeRate ChangeLocation ChangeStatus ChangeEffective Date* MM slash DD slash YYYY Occupational Information (Hiring/Rehiring/Other)Employee Name* First Last First Day Worked MM slash DD slash YYYY Employee Email Address* Job Title*ScooperRetail AssociateIce Cream SupervisorRetail SupervisorAssistant ManagerIce Cream ManagerRetail ManagerStore ManagerDepartment (Check All That Apply) Ice Cream Retail Employment Type (Status)Full TimePart TimeSeasonalStudentCasualRate Of Pay** If Existing Rate is Changing, Please Explain BrieflyWork Permit Number (Optional)Work Permit Expiry (Optional) MM slash DD slash YYYY TERMINATION / LEAVEEmployee Name* First Last Last Day Worked* MM slash DD slash YYYY Reason for Termination*QuitReturn to SchoolEnd of SeasonShortage of WorkLeave*Dismissal**Work Visa ExpiryCommentsRehirable Yes No ** Notice Pay Yes No * Leave TypeIllness/InjuryMaternityParentalCaregiverPersonalOtherCommentsAUTHORIZATIONStore Manager / Hiring Manager Name* First Last Date* MM slash DD slash YYYY FOR PAYROLL ONLYEmployee #ESS Access Setup Activated Suspended ROE Issued Yes CommentsPayroll/Operations Signature Date MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged.