Request for Pay Increase- Form

Effective 1/1/25:

To better manage our labor costs in light of ongoing discussions around profitability, we will not be offering pay increases outside of the established performance review cycle. This decision is necessary to help control expenses and maintain financial stability.

If you have a request for high flight risk team members, please submit an email to your RM & Director for review. HR approval required.

Date

State

Director*

Regional/Area Manager*

Salary or hourly request?*

Employee Name*

First NameLast Name

Office Location

Employee's Hire Date

Date

Office Location

Has RM approved this request prior to submitting?*

Has Director approved this request prior to submitting?*

Director must approve prior to submitting this JotForm.

Manager requesting pay increase

First NameLast Name

Is this for performance review cycle 2025?*

Performance review cycle kicking off May 2025

Position

Position type (ex: full-time/part-time)

Position Change (if applicable)

Current hourly rate or salary?

Recommended hourly rate?

Current Hourly Rate or Salary ($)

New Hourly Rate ($) or Salary - requested

% Difference

Last pay increase & amount?

Is this employee a A, B, C player*

A - exceptional performer must retainB- average performerC- do not need to retainOther-Employee asking for increase

Reason for increase

Performance Merit- increase (employee meets expectations)Performance Merit- increase (employee exceeds expectations)Market AdjustmentInternal Equity AdjustmentRetention- employee is considered high risk & we want to keep in organizationEmployee requested increasePromotionOther

Has Employee completed all compliance training. This is required before any increase is provided. Please confirm with Jalisa.Isler@brushandfloss.com if unsure.*

YesNo

Please provide as much detail below per the selection you made above (reason for increase) - ex: employee has taken additional responsibility, etc.:

Do you recommend employee for a pay increase?

YesNoNot at the rate they are requesting

Please upload copy of current employee performance review

Browse Files

You can still complete performance review for employee (even if they didn't complete their assessment)

Comments

REQUEST FOR PAY INCREASE FORM