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Internal - Payroll Change Request

Step 1 of 4

Reason for Request*
- New Hire
- Promotion
- Termination

Team Member*
First Last
Team Member's Personal Email*
Phone*
Title*
Direct Supervisor*

Pay Type*
- Hourly
- Salary
- Per Invoice
Current Salary
Proposed Salary
Current Hourly Rate
Proposed Hourly Rate

Effective Date*
Date Format: MM slash DD slash YYYY
Approved and Submitted by:
Name
This field is for validation purposes and should be left unchanged.