Employee Raise Request
Employees Name:
*
First Name
Last Name
Current Pay Rate:
*
Please enter the current pay rate.
New Pay Rate:
*
New Pay Rate
Effective Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date which new rate takes effect.
Has this employee had a Performance Review?
*
Yes
No
Reason for Pay Increase/Decrease:
*
Please enter the reason for this employees pay increase/decrease.
First Name
Last Name
requests the raise for the employee
Submit
Should be Empty: