Human Resources - Wayne State University
1371600000SALARY ADJUSTMENT FORM – Non-Represented EmployeesEmployee: FORMTEXT Enter employee name Banner ID: FORMTEXT 000000000 Job Title: FORMTEXT Enter job title Effective Date of Adjustment: FORMTEXT M/D/YYYYSchool/College/Division: FORMTEXT Enter S/C/D Department: FORMTEXT Enter departmentSupervisor Name and Title: FORMTEXT Enter supervisor name/title Phone: FORMTEXT ###-####BUSINESS RATIONALE - Indicate which of the following apply: FORMCHECKBOX Promotional increase FORMCHECKBOX Salary adjustment is necessary to provide internal equity with peers FORMCHECKBOX Salary adjustment is necessary to correct salary compression caused by a new hire FORMCHECKBOX Salary adjustment is necessary to retain a key employee FORMCHECKBOX OtherREQUIRED: Salary Adjustment Justification FORMTEXT Provide narrative description of salary adjustment justification. Box will expand to fit your text.Amount of Salary Adjustment FORMCHECKBOX INCREASE or FORMCHECKBOX DECREASEEmployee’s current base annual salary $ FORMTEXT ?????Amount of proposed increase (decrease)$ FORMTEXT ????? which is FORMTEXT ?????% of base pay Employee’s NEW base annual salary $ FORMTEXT ?????For Temporary Salary Adjustments, please provide the Begin and End Dates of the assignment:Begin Date: FORMTEXT M/D/YYYYEnd Date: FORMTEXT M/D/YYYYComment: FORMTEXT Box will expand to fit your text.Supervisor’s Signature: ____________________________________Date: FORMTEXT M/D/YYYYBusiness Affairs Officer’s Signature (Funding Verification): _____________________________ Date: FORMTEXT M/D/YYYYHR Director or Consultant’s Signature: _____________________________________ Date: FORMTEXT M/D/YYYYAPPROVALSDean, Assistant/Associate/Sr. Associate Vice President’s Signature: ________________________Date: FORMTEXT M/D/YYYYProvost/Vice Presidential approval is required for any proposed salary increase that exceeds 10% and/or for any salary increase for an employee reporting directly to a Dean, Assistant/Associate/Sr. Associate Vice President.Provost/Vice President’s Signature: ________________________________ Date: FORMTEXT M/D/YYYYPresidential approval is required for any proposed salary increase for the Provost or Vice Presidents or for any salary increase for their direct reports.President’s Signature: _________________________________ Date: FORMTEXT M/D/YYYY ................
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