Employee Change in Pay Rate Form LBK

Employee Change in Pay Rate Form

Date* (mm/dd/yyyy)

Effective Date : ***All raises will not go on the following check. They will be applied to the second check after the date of the raise.***

Justification for change in pay rate

Direct Supervisor*

Employee Signature*

Regional Manager*

***Remember that no raise will be communicated to the employee until all approvals have been received.Nothing in this document, including any recitation of a pay rate over a certain time period or designation of an annual review date, is intended to create a contract of employment for a specific term. All employment is at will.

Name of Employee*

Date of Hire* (mm/dd/yyyy)

Last Change in Pay Rate* (mm/dd/yyyy)

Current Pay Rate*

New Position, If any

New Pay Rate*

Approvals

Submit

Employee Change in Pay Rate Form

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