Pay Increase Form
HR FORMS
Last Name
*
 /
Month
 /
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employee Name
*
Mr.
Mrs.
Miss
-
Prefix
First Name
Employee ID #
*
Job Title
*
Employment Status
*
Please Select
Full-Time
Part-Time
Temporary/Contract
Current Salary ($)
*
Type of Increase
*
Temporary Additional Duties
Permanent Additional Duties
Equity
Counteroffer
Salary % Increase
*
Recommended Salary ($)
*
Effective Date
*
 /
Month
 /
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Justification for Salary Increase
*
Supervisor Signature
*
Request Status
*
Reason (if denied)
*
Vice President Signature
*
Submit
Should be Empty: