Request for Pay Increase- Form

REQUEST FOR PAY INCREASE FORM
Effective 10/23/24: All Pay increases for remainder of the year will be on hold as we finalize labor budgets accordingly.

Only pay increases for:
- High performers [must retain]
- Promotions
Please discuss any pay increases directly with your RM and Director before submitting this form. ALL Pay increases will be reviewed and must be approved by Director and Heba Abdel-Rahman, Head of HR. Please do not communicate to employees until pay increase is approved by appropriate person.

Please note*- Employee/Labor costs directly impact the bottom line, ensure we are requesting pay increases that truly reward performance, internal equity, etc.
Date

MonthDayYear
Date
State
Director*
Regional Manager*
Employee Name

First NameLast Name
Office Location
Employee's Hire Date

MonthDayYear
Date
Office Location
Has RM approved this request prior to submitting?*
Has Director approved this request prior to submitting?*
Manager requesting pay increase

First NameLast Name
Position
Position type (ex: full-time/part-time)
Position Change (if applicable)
Current hourly rate or salary?
Recommended hourly rate?
Current Hourly Rate ($)
New Hourly Rate ($) - 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
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) Cancelof
Comments
Should be Empty:

REQUEST FOR PAY INCREASE FORM