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Request For Salary Change Form Template

Streamline Your Salary Change Requests with This Template

Feeling undervalued or underpaid can hinder your motivation at work. This salary change form template is designed for employees like you who want to formally request a pay rate adjustment. With this straightforward form, you can detail your reasons for the request, provide evidence of your achievements, and set the stage for a successful discussion with management. Simplify your communication, ensure professionalism, and increase your chances of a favorable outcome without any coding needed-explore the live template today.

Full name
Employee ID
Job title
Department
Work email address
Work phone number
Type of salary change requested
Market adjustment
Merit increase
Promotion-related increase
Equity adjustment
Retention adjustment
Other
Please Specify:
If other, please specify
Current base salary amount
Pay frequency
Annual
Monthly
Biweekly
Hourly
Other
Please Specify:
Currency
USD
EUR
GBP
CAD
AUD
INR
Other
Please Specify:
Requested new base salary amount
Requested effective date
Primary justification
Increased responsibilities
Promotion
Market rate alignment
Performance and results
Retention risk
Internal equity
Certification or qualification achieved
Other
Please Specify:
Provide a concise summary of contributions and responsibilities supporting this request
Time since last salary change
Less than 6 months
6-12 months
1-2 years
2-3 years
3+ years
Not applicable
Most recent performance rating
Poor
Fair
Good
Very good
Excellent
Not applicable
Manager name
Additional context, links, or notes (optional)
Have you discussed this request with your manager?
Yes
No
I confirm the information provided is accurate and complete
Yes
No
Electronic signature (type your full name)
Signature date
Preferred contact method for follow-up
Email
Phone
Either
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Paper art illustration representing a salary change request form for FormCreatorAI article

When to use this form

Use this form when you propose a merit increase, promotion, market adjustment, counteroffer, or temporary stipend. It centralizes the request, captures approvals, and helps payroll apply the new rate on time. HR and finance gain a clear audit trail; employees get transparent, written confirmation. Use it for changes tied to role updates, team transfers, or location shifts that alter pay. If you are updating multiple payroll items at once, pair it with the Employee payroll change form. For brand-new positions or headcount approvals before pay is set, start with the New hire request form, then submit the pay update once the role is confirmed.

Must Ask Request For Salary Change Questions

  1. What is the proposed new base pay and pay type (hourly or salaried)?

    This ensures payroll sets the correct amount and classification, reducing errors and compliance risk. Clear numbers help approvers gauge your budget impact and compare with bands or market data.

  2. What is the effective date and the first pay period this change should appear in?

    This prevents off-cycle adjustments and late payments. If timing ties to a start date, coordinate with the New hire onboarding form so your new hire is paid correctly on day one.

  3. What is the business reason for the change (promotion, performance, market, equity, role change, correction)?

    Capturing the rationale supports fair, consistent decisions. It gives your HR team data to audit outcomes and compare similar cases.

  4. Which cost center, budget, or project will fund this change?

    Funding details help finance validate budget availability before approval. They also speed your downstream updates in accounting and reporting.

  5. Who must approve this request, and have they approved it?

    Listing required approvers and timestamps creates a clear trail and reduces back-and-forth. If the change accompanies a role move or new employee, align details with the New hire information form to keep records consistent.

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