Employee Payroll Change Form
Employee Information
Employee Name
First Name
Last Name
Email Address
example@example.com
Date of Hire
-
Month
-
Day
Year
Date
Job Title
Department
Payroll Change
Please select the reason for adjustment.
Promotion
Merit Increase
Change in Salary Grade
Part-Time to Full-Time
Temporary to Regular
Other
Remarks on the salary adjustment:
Current Salary ($):
New Salary ($):
Percent Increase:
Effective Date
-
Month
-
Day
Year
Date
Date
-
Month
-
Day
Year
Date
Employee's Signature
Manager's Signature
Submit
Should be Empty: