Salary Review Request
This form allows an employee to request a review of his/her salary.
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Description
Salary Review Request
Employee Name ________________________________
Department __________________ Title _________________________
Please accept this as my formal request for a salary review.
Current Salary _______________
Date of Last Raise _______________
I am requesting the following change to my salary:
I believe this change to be acceptable and fair because:
_________ _________________________________
Date Employee Signature
Supervisor's Comments:
_________ _________________________________
Date Supervisor Signature
