UTNC Wage Grid Correction Form

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If you believe your placement on the wage grid is inaccurate, please fill out this form.

First and Last Name *

Employee ID (Not NUID) *

Phone Number *

Hire Date *

YYYY

Years of Service at Kaiser *

Discipline *

OT/PT Staff Therapist

OT/PT Senior Therapist

OT/PT Clinical Specialist

Speech Therapist I

Speech Therapist II

Speech Therapist Specialist/III

Are you a per diem and/or short hour therapist? *

Yes

Hourly Wage PRIOR to Wage Grid Placement (What was your hourly rate prior to 2/4/22 pay check?) *

Hourly Wage AFTER Wage Grid Placement (What hourly rate is on your 2/4/22 paycheck?) *

Anticipated Correct Hourly Wage (What is the hourly rate you expected based on the wage grid calculations?) *

Based on your hourly rate on the 2/4/22 paycheck, which step were you placed on? *

Step 1

Step 2

Step 3

Step 4

Step 5

Refer to the grid above. Which step SHOULD you be on according to the directions? *

Step 1

Step 2

Step 3

Step 4

Step 5

Type of Wage Discrepancy *

Recent work anniversary

Missed longevity step

Missed longevity differential

Missed per diem/short hour differential

Required

Optional explanation of grid placement error:

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