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Salary Adjustment Request Form




Administration and Finance



Human Resources


Salary Adjustment Request Form









In order to be able to consider the impact on the budget of such requests if they are approved, a fund should be established each budget year to make resources available for such adjustments in a way that will not cause the college to overspend. In order to implement any salary adjustments of this type, it is recommended that there be two periods during the year when such requests will be received and reviewed and two times during the year when such adjustments will be effective.







Adjustments would take effect either on January 1 or July 1 of any particular fiscal year. In order to be in position to make such adjustments, the process of requesting and reviewing must take place in advance of those dates. The minimum amount of time to receive, consider and plan for such adjustments should be 90 days prior to any adjustment becoming effective. This means that for any adjustments contemplated for January 1 affectivity the initial request should be received by the CAO not later than October 1. For July 1 affectivity, the request should be received by the CAO not later than March 1.

The suggested time for CAO review is 30 days. The suggested time for Presidential consideration and decision is 30 days. The results in the final 30 days for the CFO to consider the impact on the budget and make a final recommendation to the ELT and communicate to the proper offices in HR and Payroll to make the necessary adjustments in time for the effective date.

**Note; be sure to refer to each unit(s) labor agreement for specifics with regards to request for salary adjustment (prior to completing form).


Please use the form on page 2 to request pay adjustments


Request for Salary Adjustment

Check Box that applies: AFSCME APA Non-Unit

Employee Information

Employee Name:




Employee ID Number:




1. Most recent Performance Evaluation (you must attach a copy of his/her evaluation)

2. Description of significantly expanded responsibilities:

Detailed Reason for Pay Adjustment:





3. New Academic Degree or New Professional Credential (attach transcript or credential proof):

Adjustment Details

Effective Date:

Next Review Date:

Change Amount:

New Salary Amount:

New Salary Amount:


Supervisor Signature:


V.P. Administration and Finance/CFO:








Approved by

Vice President/Date



Approved by




Revised Date


Spring 2011



Last modified at 6/27/2012 4:11 PM  by Hoxha, Anisa