HR Adjustment Form

Employee Name

First Last

Employee Email

Line Manager's Name

First Last

Line Manager Email

Reason for Adjustment

Type of Change

Permanent

Temporary

Date From

Date from when you want the adjustment to start.

Date To

Date from when you want the adjustment to end.

Job Title

Parish/Department Name

Commencement Date

Please specify if the hourly rate is the same or new

Same

New

Please enter the new hourly rate

Current Hours Worked

Please complete current start & finish time for each day of work.

Monday Start

Monday End

Monday Total Hours

Tuesday Start

Tuesday End

Tuesday Total Hours

Wednesday Start

Wednesday End

Wednesday Total Hours

Thursday Start

Thursday End

Thursday Total Hours

Friday Start

Friday End

Friday Total Hours

New Hours Worked

Please complete new start & finish time for each day of work.