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Get Employee Status Change Form 2015-2024

_________________________________________________________________________ DT #: ___________ Location Name: _________________________________ Position: ____________________________________________ Effective Date: ______/______/______ Date of Birth: ______/______/______ E-mail: ________________________________________ Employee Status Type of Change: New Hire Rehire Employee Status Change Regular Full Time (30 hours or more) Hours per week: _________ Regular Part Time (29 hours or less) .

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