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Nly: Address: Phone: City, State, Zip: Supervisor: Comments: Social Security number should never be written on this form NEW HIRES Status: Department/Code: Title/Position: Rate per hr/Annum: $ Salary schedule/Step: Work schedule (Days/Hrs): Total hours/week: CHANGES FOR CURRENT EMPLOYEES Status: Status: Current title/Position #: New Title/Position #: Current department/Code: New Department/Code: Current salary schedule/Step: New Salary Schedule/Step: Current rate per/Annum:.
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