Title Page
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Site conducted
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Date Form Completed
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Prepared by
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Employee Name
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Date Change Effective From
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Change in Salary
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Details
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Change in Title
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Details
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Change in Department
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Details
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Change in Contracted Hours
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Details
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Change in shift pattern (non contractual)
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Is this change permanent, or on a secondment
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Please give Length of Secondment eg 6 months
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Please give Details
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Employee Name and Signature
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Line Manager Name and Signature