subject_line
Pay Rate Change Request
Employee ID
* Employee Name
Pay Rate Changes
Current Pay Rate
$ or %
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Percentage?
New Rate?
% Increase?
New Pay Rate
$
0.00
Calculate
New Pay Rate (2)
% Increase (2)
0.00
Calculate
Effective date
(Must pick a Sunday)
+
Date of Hire
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+
Date of last increase
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+
Amount of last increase
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Other Changes
Current Per Diem
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New Per Diem
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Current Truck Pay
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New Truck Pay
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Notes / Comments
Requestor Comments / Notes:
* Form submitted by
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Please Note
Clicking the "Submit" button will forward this request to the payroll department & send a copy to the requestor's email address.