Employee Name:	Effective Date:
SECTION 1 – Pay Action Request
Promotion
Voluntary Transfer:	Competitive	Non-Competitive
Voluntary Demotion
Temporary Pay:	Acting in Role of Higher Band	Acting in Role of Same Band	A Special Time-Limited Project
Military Pay Supplement
Competitive Offer
Recognition Bonus (only a brief explanation /justification is needed for this transaction):
Role Change:	Upward	Downward	Lateral
In-Band Adjustment:	Change in Duties	Professional/Skills Development	Retention	Internal Alignment
In-Band Bonus
Disciplinary Salary Action
SECTION 2 – Justification and Support
Provide a brief explanation/justification for specified action:
Explain how this transaction is supported by the appropriate pay factors below (required for all pay actions except for Recognition Bonus):
Agency Business Need:
Duties and Responsibilities:
Performance:
Work Experience and Education:
KSAs and Competencies:
Training, Certification and Licensure:
Internal Salary Alignment:
Market Availability:
Salary Reference Data:
Total Compensation:
Budget Implications:
Long-Term Impact:
Current Salary:
Attachment:	Yes	No	Attach required documentation, such as Employee Work Profile, organization chart and other information needed for approval.
SECTION 4 – VDOF Approvals
Manager Name (Print)	Manager Signature	Date
Unit Director Name (Print)	Unit Director Signature	Date
Human Resources Director Name (Print)	Human Resources Director Signature	Date
Rob Farrell
State Forester Name (Print)	State Forester Signature	Date