Request for Employee Job/Pay Change
Manager to Complete and Submit to HR
EMPLOYEE NAME
*
Date of Hire:
-
Month
-
Day
Year
Date
Employees Email
example@example.com
MANAGER NAME
*
Employee Current Job Title
*
Current Pay Rate
Current Employment Status
*
Please Select
FULLTIME
PART TIME
TEMPORARY
Current Payroll Status
*
Please Select
HOURLY
SALARY
DAY RATE
SALARY + COMISSION
New Job Title
*
Request New Pay Rate
New Employment Status
*
Please Select
FULLTIME
PART TIME
TEMPORARY
New Payroll Status
*
Please Select
HOURLY
SALARY
DAY RATE
SALARY + COMISSION
Reason for change
*
Promotion
Demotion
Performance
Merit
When will this change be made effective?
Please Select
This Payroll Cycle
Beginning of Next payroll Cycle
Specific Date
Date Change Effective?
-
Month
-
Day
Year
Date
Will this position require a manager change?
Yes
No
New Manager Name
First Name
Last Name
New Manager Email
example@example.com
Other Notes
Additional Pay Change Information (including commission rate)
Current Manager Signature
*
Current Manager Email
example@example.com
Employee Signature (printed)
HR Director Signature (printed)
Submit
Should be Empty: