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Back to Forms for 'Compensation & Benefits'.





Employee Name _____________________________


I.D.# _____________________________


Location _____________________________


Department _____________________________



                                          Current                                              Proposed


Title                    ________________________            ________________________


Salary Grade      ________________________            ________________________


Base Rate          ________________________             ________________________


Merit Amount    ________________________             ________________________



Amount             ________________________             ________________________


Other Amount    ________________________             ________________________


Bonus               ________________________             ________________________


Effective Date   ________________________             ________________________

Type of Proposed Increase:


[   ] New Hire      [   ] Merit      [   ] Promotion      [   ] Other ___________________


Date of Last Increase ______________________



Type of Last Increase:


[   ] New Hire      [   ] Merit      [   ] Promotion      [   ] Other ___________________



Explanation for Proposed Salary Increase __________________________________ __________________________________________________________________ __________________________________________________________________





Supervisor __________________________                Date ____________________


Manager ___________________________                 Date ____________________


Div. Vice-Pres. ______________________                 Date ____________________


Personnel Dept. ______________________                Date ____________________

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