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Employee Promotion Authorization Request

Current Date

Employee: First Last Current Job title of signator, authorized signature or signer. Contract Job Title Current Department: Department Current Supervisor: Supervisor New Title: Insert the New Job Title New Department: New Department, New Supervisor: the New Supervisor Name, Effective Date(s) Effective Start Date: Start Date Current Salary: the Employee's Current Salary, Proposed Salary: the Employee's New Salary. Instructions: Supervisor must complete the following form and file it with the Human Resources Department. All Employee Promotion Authorization Requests must have an attached job description.

Please state the reason(s) for selecting this employee for promotion.

Employee Job Codes (Please check all that apply) Employee's Current Status: ? Full-time ? Part-time ? Budgeted ? Non-budgeted Additional Notes:

Changes to Benefits * Verified by Human Resources. Please note any increase or decrease of benefits as a result of this promotion.

Sick Pay*: hours

Personal Days*: hours

Maternity Leave*: hours

Compensatory Time*: hours

Personal Days*: hours

Vacation Days*: hours

Supervisor is required to sign this Employee Promotion Authorization Request in order to gain Company approval and verify the descriptions of salary, schedules, benefits, job title, and duties. Upon approval by the Company, both Employee and Supervisor will receive written notification of said approval from the Company Human Resources Department.

Supervisor Signature Date

For Office Use Only

Human Resources Manager Date