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REQUEST FOR CHANGE IN EMPLOYMENT STATUS

 

I am requesting the following change(s) in my employment status with [name of company]:

 

__ Transfer in position from _______________ (my current position) to _______________ (the position I would like to have).

 

__ Change in hours of work from my current schedule of ______ to ______ to the new hours of ______ to ______.

 

__ Change in days of work from my current schedule of ______ to ______ to the new days of ______ to ______.

 

__ Change in work location (if applicable - this would usually apply to telecommuting requests).

 

Result(s) of transfer in position: I understand that if the Company grants my request, the following change(s) will also occur:

 

__ Change in pay rate from ______ per ______ to ______ per ______.

 

__ Change in department from _____________ to _____________.

 

__ Change in supervisors from _____________ to _____________.

 

__ Change in schedule from ______ to ______ to the new hours/days of ______ to ______.

 

__ Change in work location from _____________ to _____________.

 

__ [Loss][Addition] of [bonus]/[parking space]/[type of benefit]/[access to certain type of training]/[access to type of resource].

 

I understand that if the Company decides to grant my request and hires, transfers, trains, or otherwise changes the employment status of any employee in response to it, I will most likely not be able to withdraw my request at a later date and that the change will remain in effect.

 

I further understand that no particular change is guaranteed; that if the Company grants my request, it may later rescind the decision at its discretion; that any granting of such request is contingent upon my meeting the performance standards for my position; and that the granting or denial of this request will not alter the employment-at-will relationship that I have with [name of company].

 

/signed/

 

____________________
Employee

 

____________________
Date

 

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