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Wage Increase Form Template

Effortlessly streamline pay increase requests with our form

Are you struggling to properly request a pay increase at your workplace? This Wage Increase Form Template helps employees like you present salary requests clearly and effectively, enabling better consideration from your employer. Whether you're aiming for a higher salary based on performance, a change in responsibilities, or market adjustments, this template delivers a professional layout for your needs, simplifies the approval process, and ensures compliance with standard HR practices. Explore how easily you can create your own with this ready-to-use template.

Full name
Job title
Department or team
Employee ID
Work email
Phone number
Work location (city, state/country)
Hire date
Employment status
Full-time
Part-time
Temporary
Contractor
Intern
Pay type
Hourly
Salaried
Commission
Other
Please Specify:
Current base pay rate (include unit, e.g., $28/hour or $65,000/year)
Pay frequency
Weekly
Biweekly
Semi-monthly
Monthly
Other
Please Specify:
Currency (e.g., USD, EUR, GBP)
Average hours worked per week
Date of last pay review
Last increase amount or percent (if applicable)
Overtime eligible
Yes
No
Type of increase requested
Merit
Promotion
Market adjustment
Cost of living
Equity/compression
Retention
Other
Please Specify:
Requested effective date
Requested new base pay or percent increase
Primary reason for request
Key achievements since last review
Additional responsibilities or scope increases
Market data or benchmark sources (summarize and include links if available)
Links to supporting documents (optional)
Are critical skills in this role currently hard to hire or retain?
Yes
No
Not sure
Most recent performance rating
Poor
Fair
Good
Very good
Excellent
Overall, I meet or exceed core job expectations
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Any disciplinary actions in the last 12 months
Yes
No
Prefer not to say
If applicable, provide brief context on performance or attendance notes
Any attendance concerns in the last 12 months
Yes
No
Prefer not to say
Immediate manager name
Manager email
Department head name (if applicable)
Budget is available for this request
Yes
No
Not sure
Manager comments
HR reviewer name
HR reviewer email
Approved new base pay or percent (if approved)
Approved effective date (if approved)
HR decision
Approve
Approve with modification
Defer
Decline
Needs more information
Typed name as signature
Signature date
I confirm the information provided is accurate and understand this is a request, not a guarantee of pay change
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
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Paper art illustration related to wage increase form template with decorative elements and text layout

When to use this form

Use this form when you authorize a change to an employee's hourly rate or salary. It fits annual merit cycles, mid-year market adjustments, promotions, counteroffers, or post-probation increases. Managers record the reason, new rate, effective date, and approvals in one place so HR and payroll can update records on time and avoid pay errors. For broad, company-wide adjustments, pair this with the Employee raise form. If the change shifts someone to a weekly pay schedule or alters timing, coordinate with the Payroll weekly payment form. When an increase affects withholdings or garnishments, confirm updates with the Payroll deduction form. The result: a clear audit trail, accurate pay, and fewer back-and-forths.

Must Ask Wage Increase Questions

  1. What is the current pay rate and the proposed new rate (hourly or salary)?

    Give exact amounts and pay type to prevent guesswork and costly re-runs. This also keeps your records aligned with your Pay increase form for consistency.

  2. What is the effective date and which payroll period should this change apply to?

    Clear timing ensures payroll applies the increase in the correct check and handles any proration. It also helps avoid retro pay and off-cycle processing.

  3. What is the primary reason for the increase (merit, promotion, market, equity, retention, COLA)?

    Stating the reason supports fair decisions and consistent policy use. It enables HR to report trends and verify any required documentation.

  4. Who approved this change and what cost center or budget will fund it?

    Named approvers and a funding source reduce compliance risk and prevent unfunded commitments. Finance can reconcile increases faster during audits.

  5. Will this change affect overtime rates, bonuses, or deductions, and has the employee been notified?

    Calling out impacts helps payroll calculate new overtime multipliers and adjust related pay elements. Written notice reduces disputes and creates a clear audit trail.

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