Notification of Supervisor Change Form

Whenever an employee’s reporting structure changes and the employee is moved
to a new supervisor, the new supervisor also known as the “receiving supervisor”
needs to complete and submit this form to HR to initiate updating of the employee's record.

Section 1: To Be Completed by the Receiving Supervisor
Today's Date Today's Date / MM / DD YYYY
Name of Employee/s Who Will Now Report To The Receiving Manager
Department
Name of Receiving Supervisor: Name of Receiving Supervisor: First Last
Effective Date of the Change: Effective Date of the Change: / MM / DD YYYY
Supervisor Notes
Section 2: This section of the form must be signed by receiving supervisor.
Receiving Supervisor’s Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY

Notification of Supervisor Change Form

Notification of Supervisor Change Form

Section 1: To Be Completed by the Receiving Supervisor

Section 2: This section of the form must be signed by receiving supervisor.