Fillable Salary-Adjustment-Request-Form-2017-v-4-0-Enterable Idaho State University

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Salary-Adjustment-Request-Form-2017-v-4-0-Enterable Idaho State University

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Salary Adjustment Request
The purpose of this form is to be used for salary adjustment proposals within an employee’s current position/classification
addressing the areas of meritorious service, internal or external market equity, job growth, and/or retention. Please take
the time to complete the questionnaire as completely and accurately as possible. Thoroughness in providing the
information is essential in assuring the proper salary is established. If the proposal is supported by the respective
management team, the HR Office will review internal equity and external market factors while also reviewing applicable
ISU and State Policy. The ISU Employee Compensation Policy, ISUPP 3150 is available for review at
http://www2.isu.edu/policy/3000/index.shtml. All proposals are contingent upon the availability of funds. This form is to
be used to review salary adjustment proposals only. Requests to modify the classification of a position should be done
using the Position Description Questionnaire. If this position is grant funded, the availability of funding should be
verified with Sponsored Programs prior to submission.
• Position Type:
Classified
Faculty Non-Tenure Track
Faculty Tenure Track
Non-classified
Adjustment Type:
Ongoing Base Adjustment
Temp Adjustment Ending:________________________
• Incumbent Name: ______________________________________________
COMPLETE ALL APPLICABLE
AREAS FOR PROPOSED SALARY
CHANGE
CURRENT APPOINTMENT PROPOSED APPOINTMENT
Department
Title
Action Date, Position Number
and FTE (annualized % time worked)
Potential End Date
PCN
FTE
Proposed Effective Date
PCN
FTE
Appointment Months per
Year
12 month
9 month
Other
mo.____
wks____
12 month
9 month
Other
____mo.
____ wks
Salary Information
Annual Base Bi-weekly
Hourly
Rate
Annual Base Bi-weekly Hourly rate
Budget to be charged
Index Number(s) Amount Percent Index Number(s) Amount Percent
PI
initial
Identify Source(s) of Additional Funding Needed (if applicable) For Account Director/UBO Review/Completion
Index
Reg Sal Amt
Reg Sal PCN
Irreg Sal
Fringe
Insurance
Travel
Operating
Total
Provide details of how the identified source(s) of temporary/ongoing funding will be realized if applicable. Provide revenue and/or
expense analysis/projections to show fiscal sustainability. Attach additional sheets if necessary.
2
POSITION INFORMATION
1. Purpose: Indicate the primary and secondary reason(s) for this request as applicable:
Reason
Primary Concern
Secondary Concern
Employee Performance
Internal Equity
External Market
Additional Duties
Retention
Other, indicate below
Other, explanation: ________________________________________________________________________________
2. Justification for Proposed Salary Increase. Justification must include why salary adjustment is being requested
outside of the annual merit increase process. Why is it in the best business interest of the unit to consider this salary
adjustment at this time? Attach additional sheets if necessary.
3. Attach documentation to support justification for proposed salary adjustment such as, but not limited to: 1) revised
job description if additional duties have been assigned, 2) internal salaries of similar departmental positions for internal
equity concerns, 3) relevant external market data if the adjustment pertains to market concerns, or 4) offer letter from
competing organization if adjustment is due to a competitive salary offer.
4. Anticipated outcome if salary adjustment is not approved: What is the anticipated outcome to the department if
the proposal is not approved? Describe what alternate scenarios or actions have been considered in the event this proposal
is not approved at this time. Attach additional sheets if necessary.
SIGNATURE APPROVALS REQUESTING HR REVIEW
I confirm this document has been completed accurately and a potential salary adjustment is in the best business interest
of the department/college, pending HR review of applicable policy and the availability of funds.
Supervisor Name:
Signature:
Chair or Department Head Name:
Signature:
University Business Officer Name:
Signature:
Dean/AVP/Director Name:
Signature:
Vice President/Senior Executive Name:
Signature:
Upon completion, please forward to Human Resources, Mail Stop 8107 or hr@isu.edu
HR APPROVALS FOR IMPLEMENTATION – FOR HR/BUDGET USE ONLY
Position Classification/Title:
HR - Attach Compensation Analysis
Effective Date of Adjustment:
FLSA Designation:
Approved Rate of Pay/Salary:
Approved Pay Grade:
Budget Confirmed Signature:
Date:
HR Approval Signature:
Date
Form Revised July, 2017
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Salary-Adjustment-Request-Form-2017-v-4-0-Enterable Idaho State University

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Completed 15 November 2019

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