Payroll Change Request
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1PAYROLL CHANGE REQUEST
Employee Name:____________________________________________ Red ID #: ________________________
Department Name: _____________________________ Employee No: _____________ Date: _______________
A
�
�
WAGE INCREASE
DECREASE
Evaluation Form or explanation must be attached
Effective Date (must be first day of pay period): _______________________ Retro:
� YES
� NO
Current Rate: _____________________ Current Range: ____________________ Step: ___________________
New Rate: _______________________ New Range: _______________________ Step: ___________________
Date of last raise: ______________________________
All affected locators: ________________________________
_________________________________
________________________________
__________________________________
B
CLASSIFICATION CHANGE
Effective Date _______________________ Check One:
� RECLASS
� TRANSFER � PROMOTION
Current Job Title: _________________________________ New Job Title: ______________________________
Current Rate: _____________________ Current Range: ____________________ Step: ___________________
New Rate: _______________________ New Range: _______________________ Step: ___________________
All affected locators: ________________________________
_________________________________
________________________________
__________________________________
C
�
�
HOME DEPARTMENT CHANGE
LOCATOR ADDITION
Effective Date _______________________
Current Home Locator: ____________________________ New Home Locator:: _________________________
Additional Locator Codes: ________________________________________ Pay Rate: ___________________
________________________________________ Pay Rate: ___________________
Job Assignment: ________________________________
Approval Signatures
___________________________________________
___________________________________________
Supervisor
Date
Manager
Date
11/04
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Parent category: Business