Pay Rate Form
All fields are required in order to process pay rate and/or pay rate change. Unless you are hiring someone, this must be turned in prior to the beginning of the pay period. Once this form is submitted, it will be sent to Leanne Clark and Kacey Hijmans.
Your Name
*
First Name
Last Name
Employee Name
*
First Name
Last Name
Employee Number
*
Current Rate of Pay
*
New Rate of Pay
*
Reason for Change
*
Today's Date
*
-
Month
-
Day
Year
Effective Date of Change
*
-
Month
-
Day
Year
Manager Signature
*
Submit
Should be Empty: