Fillable Pay Increase Approval Request Form printable pdf download

Pay Increase Approval Request Form

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PAY INCREASE APPROVAL REQUEST

School/Division/Department: ___________________________________________________________________________

Employee Name: ___________________________________________ Employee I.D. Number: ____________________

Job Title: __________________________________________

Job Code: ________

Level: ______

□:

□

PROPOSED:

Merit ___%

: Market Adjustment (not related to performance) ___%

Funding Source(s): ___________________________

ATTACH THE FOLLOWING DOCUMENTS TO THIS FORM:

1) memo explaining the justification for the pay increase;

2) benchmarking information; and

3) pay increase template spreadsheet, found at , listing all the

compensation history of the incumbent for the last 3 to 5 years.

PROPOSED PAY INCREASE INFORMATION:

Date

Reason for Increase Current Base Proposed Base %Inc Bonus Other Comp Total Comp %Total Comp

INITIATED BY (signatures):

____________________________________ Title: ____________________________ Date: _____________

Supervisor:

Title: ____________________________ Date: _____________

Supervisor’s Supervisor ______________________________

SCHOOL/DIVISION REVIEW AND RECOMMENDATION (See Staff Wage and Salary Guidelines for appropriate

signature):

Signature: ______________________________ Job Title: ________________________________Date: _____________

PAY INCREASE REVIEW:

Up to and including 5% APPROVED: ______ DENIED: ______

Excess of 5% RECOMMENDED ______ NOT RECOMMENDED: ______

Compensation Representative: _____________________________________________________ Date:_____________

PAY INCREASE REVIEW (Excess of 5%)

APPROVED: ______

DENIED: ______

Senior Vice President for Administration or Designee: ___________________________________ Date: ____________

Provost and Sr. V. P. for Academic Affairs or Designee: _________________________________ Date: ____________

April 2012

Pay Increase Approval Request Form

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