Wage Increase Form
Employee Name
*
First Name
Last Name
Department
Effective date of rate change - 1st or 16th of month -
*
-
Month
-
Day
Year
Nowsta rates may change later but that will not affect wage paid
Role for rate change
*
Current Pay Rate
*
New Pay Rate
*
Comments
Manager Approval
*
First Name
Last Name
Signature
*
Today's Date
*
-
Month
-
Day
Year
Date
Submit
Office Use Only
Manager Approved
Yes
No
Manager approval date
Approved by Manager
Initial
Date
Completed on
Date
by
blank
effective
Date
Should be Empty: