Pay Alteration Request Form

Pay Alteration Request Form
sssssValueAdmin

Pay Alteration Request Form

N
A
M
E 		Please return completed form to payroll, head office.
Employee name:
Present position: State:
Payroll number:  
Paid: (weekly / monthly etc.)  		 
 



A
L
T
E
R
A
T
I
O
N 		Proposed position:    
Proposed pay per week/annum: $
Other pay alterations proposed: $
Present rate per week/annum: $
Recommended increase per week: $
Reason for other pay alteration: $


A
P
P
R
O
V
A
L 		Effective date: (dd/mm/yy)S
Recommended: (Manager)
Approved:(Managing Director)
PAY OFFICE USE
Actioned date: (dd/mm/yy)   
Effective week ending: (dd/mm/yy)   
Back Pay:  $