Sample Salary Evaluation Request Form

The Salary Evaluation Request Form is available free to download, customize and print for your small business office or Human Resources Department.

Request templates such as the Salary Evaluation template and the Request for Review of Salary Increase or Promotion are available below for your employee supervisors, managers, employees…

These forms for the request of a salary increase or evaluation of a promotion can be a very important tool for your small business due to the difficult issues you face when an employee is inquiring about these type of requests.

Discussing an employee’s pay can be very uncomfortable and difficult for the employer and employee that is why these request forms can be so useful for your organization.

The Salary Evaluation Request form below includes the following:

  • Date of Request
  • Job Title of Position to be Evaluated
  • Current Salary
  • Name of Employee(s) in Job Classification
  • Employee(s) Current Base Pay
  • Supervisor Requesting Evaluation
  • Supervisor’s Job Title
  • Supervisor’s Contact Phone Number
  • Department Name
  • Reason for Evaluation Request
  • Human Resources Use Only: Job description included with request? yes or no, Evaluator’s name, Salary grade recommendation, Salary surveys utilized, Reasons for salary grade recommendation, Notified supervisor? if yes date and Comments.

The Request for Review of Salary Increase or Promotion form below includes the following:

  • Applicant Information: Date of Request
  • Applicant’s Name (May be filled out on behalf of the employee by the immediate supervisor.), Department
  • Please indicate one option for which you’re applying, by checking a box below.- Request for Promotion (with change in budget title, salary grade level, and salary increase) I wish to apply for consideration for promotionas a consequence of an increase in the scope and complexity of in assigned duties and responsibilities that is both significant and permanent. – Request for Salary Increase (without change in budget title or salary grade level) I wish to apply for consideration for a salary increase as a consequence of a permanent and significant increase in duties and responsibilities.
  • Applicant’s Signature (Not required if application is filed by immediate supervisor on behalf of employee) and Date Forwarded
  • Attachments – Please attach the following documents supporting your request promotion or salary increase request: Cover letter indicating specific/detailed rationale for the request, Copy of current performance program, Copy of at least the last two performance programs or as many as you believe are necessary to demonstrate the change in duties and responsibilities, Organization Chart, Other supporting documentation (may include performance evaluations, letters of recommendation from colleagues etc.)
  • Review and Recommendations: Immediate Supervisor, Next Level Supervisor (if applicable), Human Resources, Vice President and President (See form below for all the information on the rest of this form.)

Click on the link(s) to download the salary request forms below:

Salary Evaluation Request

Sample Salary Evaluation RequestRequest for Review of Salary Increase or Promotion

Sample Request for Review of Salary Increase or Promotion