California Notice of Change in Employment Status

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This notice can be used by a company based in California to inform an employee of a change in employment status. This notice can be used when an employee is resigning, being laid off, demoted, discharged, or changed from an employee to an independent contractor. This notice properly informs the employee of such change in employment status to minimize confusion. This notice is ideal for small businesses that want to inform an employee of a change in employment status.

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									California Notice of Change
in Employment Status
This notice can be used by a company based in California to inform an employee of a
change in employment status. This notice can be used when an employee is resigning,
being laid off, demoted, discharged, or changed from an employee to an independent
contractor. This notice properly informs the employee of such change in employment
status to minimize confusion. This notice is ideal for small businesses that want to
inform an employee of a change in employment status.
        NOTICE TO EMPLOYEE AS TO CHANGE OF RELATIONSHIP

TO:               _______________ [Instructions: Insert the Employee’s name] (“Employee”)
                  (SSN: _________ [Instructions: Insert Employee’s Social Security Number])

FROM:             ________________ [Instructions: Insert the Employer’s name] (“Employer”)

DATE:             ________________________ [Instructions: Insert the date]

PLEASE TAKE NOTICE THAT pursuant to Section 1089 of the California Unemployment
Insurance Code; Employer is hereby notifying Employee of a change in Employee’s relationship
with Employer as follows:

1.      Change in Employment Status. Employee’s employment status has changed as a result
of: [Instructions: Choose one] voluntary resignation /// layoff /// leave of absence /// demotion
resulting in a decrease in work hours and/or wages /// discharge /// refusal to accept available
work /// change in status from employee to independent contractor, effective
__________________ [Instructions: Insert the effective date of this change]

2.     Pamphlet. In order for Employee be fully aware of Employee’s rights the Employment
Development Department (“EDD”) encourages Employee to review the EDD pamphlet entitled
“For Your Benefit - California’s Programs for the Unemployed” (DE2320), which can be
accessed at http://www.edd.ca.gov/pdf_pub_ctr/de2320.pdf.

3.   Unemployment Insurance Benefits. In the event that Employee desires to apply for
Unemployment Insurance benefits, Employee shall submit a copy of this form to the EDD.

NOTICE SERVED ON EMPLOYEE BY: ____________________ [Instructions: Insert
method of service] by _____________________, [Instructions: Insert the name of the person
who served this document] on behalf of Employer on _____________________. [Instructions:
Insert the date of service]


________________________________
By: ________________ [Instruction: Insert the name of the Employer’s signatory]
Title: ________________ [Instruction: Insert job title of the Employer’s signatory]




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