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Temporary Salary Adjustment Justification FormApplicant’s Name:Department/Division:Classification Title:Internal Title:Class Code/Slot Number:Salary Range:Pay Band:Employee’s Current Salary:Proposed Salary with Increase:Percent Increase:Duration:State Average Salary:State Average Years of Service:Agency Average Salary:Agency Average Years of Service:Justification of TSA:Approved by:Date: ................
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