26 Full Time Part Time Status - Golden State Restaurant Group

Full Time/Part Time Status

Please complete the form below

Request Submitted By(Required)

FIRST and LAST NAME of person completing form

Today's Date(Required)

Employee Name(Required)

First Last

Please use COMPLETE legal name. The name of the Employee the form is about.

Employee Time Card Number(Required)

Last 4 Employee SSN(Required)

Current Restaurant(Required)

Current Job Title

GSRG Type

Office

Operations

Maintenance

Requested Effective Date(Required)

Must be the start of the pay period, either the 1st or the 16th of the month. If this is a critical change, please complete the form and contact out to Gracie at payroll@mcdgs.org.

Requested Benefits Status Change

File

Max. file size: 300 MB.

Employee Signature(Required)