PAYROLL EMPLOYEE COMPENSTION REQUEST
Date: _______________________________
Employee Name: _____________________________________
Z Number: __________________________________________
Company: __________________________________________
Please write complete description for issuance of additional compensation for employee. Include class taught, seminar
performed, activity, etc. and period in which it is to take place.
______________________________________________________________________ $_______________
______________________________________________________________________ ________________
______________________________________________________________________ ________________
______________________________________________________________________ ________________
______________________________________________________________________ ________________
______________________________________________________________________ ________________
_____________________________________________________________________ ________________
TOTAL $_______________
List Payment Date(s) amount should be charged to. (If compensation is to be ________________
reflected in one check only, please show only that date.) ________________
________________
ACCOUNT TO BE CHARGED:
FUND: _______________ ORG: ____________ Account: _______________ Program: _______________
___________________________________________________ ____________________________
Requester/Org. Manager Date
___________________________________________________ ____________________________
Dean/Director/Vice Pres./Exe. V.P./Provost Date
___________________________________________________ ____________________________
Budget Date