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Pay Increase Form Template

Streamline Your Employee Salary Increase Requests

Struggling to manage employee salary increase requests? This Pay Increase Form Template helps you organize and streamline these critical communications. Designed for HR professionals and managers, it ensures salary requests are collected systematically, leading to faster decisions and improved employee satisfaction. With clear fields for the type and amount of increase, effective date, justification letters, and approval status, you'll maintain compliance while simplifying the approval workflow. Plus, it's WCAG-aligned for accessibility. Try the live template to get started on enhancing your payroll process.

Use this Template (FREE) Live Preview
Full name
Job title
Department or team
Work location
Work email
Manager's name
Employment status
Full-time
Part-time
Contractor
Temporary
Intern
Other
Please Specify:
Original hire date
Time in current role
Less than 6 months
6-12 months
1-2 years
2-3 years
3-5 years
5+ years
Pay type
Hourly
Salary
Commission
Stipend
Other
Please Specify:
Current base pay (amount and currency)
Additional compensation components
Bonus eligible
Commission eligible
Overtime eligible
Shift differential
Equity/stock
Allowances
None
Requested effective date
Requested new base pay or increase amount (amount and currency)
Percentage increase requested
Requested adjustment type
Base pay increase
Promotion with pay change
Market adjustment
Retention adjustment
Other
Please Specify:
Primary reason for this request
Sustained high performance
Expanded responsibilities
Leadership or critical skills
Market rate alignment
Internal equity
Retention risk
Certification or degree completed
Other
Please Specify:
Key accomplishments over the last 12 months
New or expanded responsibilities
Market data or internal equity rationale (sources, links, or notes)
Have you discussed this request with your manager?
Yes
No
Final approved base pay (amount and currency)
Decision date
Decision
Approve
Approve with changes
Defer - need more information
Do not approve
Not applicable
Type your full name as your signature
Signature date
I certify that the information provided is true and complete to the best of my knowledge.
Yes
No
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Paper art illustration depicting a pay increase form with various icons and elements related to salary adjustments

When to use this form

Use this form when a manager requests a raise after a review, a promotion adds new duties, or you need a market or equity adjustment. It works for merit increases, retention offers, and payroll rate changes. HR, finance, and managers benefit from clean data, faster approvals, and an audit trail. The result is a clear decision and a correct update to payroll. If the change will modify HRIS records, pair it with the Personnel action notice form. When fixing a starting rate or honoring a written offer, attach the Offer letter submission form. Use one form per employee to avoid mixups, set the desired effective date, and record budget details and approvers.

Must Ask Pay Increase Questions

  1. What is the employee's current pay rate and the proposed new rate?

    This pins down the budget impact and percent change. It prevents errors and avoids follow-up emails.

  2. What is the effective date and pay period for this change?

    This prevents missed pay cycles and retro pay fixes. Payroll needs a precise start date to process the change on time.

  3. What is the primary reason for the increase (performance, promotion, market adjustment, equity, or retention)?

    The reason guides the approval path and the documentation you must attach. Clear categories keep increases consistent and fair.

  4. Which achievements or metrics justify the increase?

    Concrete results make approvals faster and defensible. Metrics also help during audits and future reviews.

  5. Has the employee completed probation or required reviews?

    Policy often limits raises during probation or before a scheduled review. If needed, confirm status with the Employee probation form.

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