Pay Rate Increase - single approval

Employment Change Request

Pay Rate Increase - Single Approval
RANDALL COUNTY EMPLOYMENT CHANGE REQUEST
Employee Name*
Department*
Effective Date*

MonthDayYear
Date
Pay Date*

MonthDayYear
Date
From Annual Salary*
To Annual Salary*
From Range
/%
BiWeekly Salary
To Range
/%
BiWeekly Salary
Is there a change in Fund or Department #: If Yes, then
Fund
Dept #
Uniform Allowance
Phone Allowance
(Please provide Court approval documentation)
Comments
Department Head Email*
example@example.com
Department Head Approval

Clear
Date

MonthDayYear
Date
Should be Empty: