Compensation Adjustment Form

Employee Name:                        

Employee ID:

Position Title:                                                          

Department:    

Adjustment Information

Reason for Adjustment   (In the space provided below please indicate the reason for the pay adjustment.)

**NOTE - Attach all supporting documentation i.e. performance/probation reviews, etc.

Effective Date                              __________________                      

Next Review Date               _________________

Change Amount                      __________________                      

New Salary Amount       _________________

Signatures

 

___________________________          

Supervisor Signature

 _____________

Date

___________________________

Human Resources Signature                

_____________

Date