Teen Court Volunteer Status Change

Name __________________________

Employer I.D. # __________________________

Department __________________________

Effective Date ________________

Title Change:

Title Grade

Present ________________ ___________

Proposed ________________ ___________

Type of Change: (check appropriate type)

[ ] New Volunteer [ ] Voluntary Resignation [ ] Promotion [ ] Leave of Absence

[ ] Other [ ] Sick Leave [ ] Transfer [ ] Layoff

[ ] Return from Absence [ ] Disability - Non-Work

[ ] Termination [ ] Disability - Work

If leave of absence, state duration - From ___________ To ___________

Comments and reasons for change: _______________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

Submitted by:

Supervisor _____________________ Title ___________ Date ______________

Approvals:

Signature_________________________ Date __________________

Signature ___________________________ Date __________________

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