This form advises you that effective 30 days following the close of this pay period or [INSERT DATE] your pay frequency will be changed as noted below:
Current Prior Pay Frequency Your New Pay Frequency
[ ] Weekly [ ] Weekly
[ ] Bi Weekly [ ] Bi weekly
[ ] Bi monthly [ ] Bi Monthly
[ ] Monthly [ ] Monthly
Following the effective date of this change, you will complete your first new pay cycle and receive your pay on [DATE].
Please acknowledge and date this form and return to the Human Resources Department by [CONTACT NAME].
Employee:
Date:
Employee # :
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