Pay Raise Request Form
Required for any pay increase.
Division Manager Name
*
Supervisor Name
*
Employee First Name
*
Employee Last Name
*
Position
*
Reason for Raise
*
Effective Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Hourly Pay Rate
*
New Hourly Pay Rate
*
Additional Notes
Submit
Should be Empty: