PAY RATE REQUEST FORM

This form is to be used by supervisors/managers to obtain a pay rate for a brand new assignment that does not yet exist in the payroll system.  Once a pay rate has been approved, you may submit an Additional Assignment Request Form.

Pay Rate Request Form

Name of the Requester *

Date of the Request *

Name of assignment *

Name of employee (if appropriate)

Detailed scope of work *

Start Date *

End Date

Average weekly hours *

Requested Pay Rate (if appropriate)

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