Human Resources Effective Date
Last Name First Name Middle Church # Church Name
Address City State Zip Code
Name/Address (to mail check to if different from above) City State Zip Code
Circuit Single Church Circuit If a circuit, please explain how you want the amount to be divided within the
circuit. Otherwise 100% of the request will to go the church named above.
Change From Change To
Office Use Only Hourly Hourly
Bonus Gross Amount (Select Payroll Deposit or Check) Payroll Deposit
(GCI Employee) Check
See Financial Manual, section 22.214.171.124
Honorarium Gross Amount (Check Only) Bonus/Honorariums for Pastors will be drawn from
Request congregation's bank account. Bonus/Honorarium Requests
for Camp Directors must have a check attached to this form
for the amount requested made payable to Grace
Comments Please explain reason for Bonus, Honorarium or Salary. For Salary change please enter amount or percentage of increase.
Treasurer, on behalf of the congregation, its advisory council and the financial committee Date
Church Comments/Initials Date
Pension Plan Comments/Initials Date
Treasurer's Office Comments/Initials Date
For Office Use Only Employee # Department Name Dept-Cost Center-Acct
*Salary increases above 3% average per year, for eligible employees, may trigger additional expenses to the congregation(s) to offset increased
pension payouts resulting from the increase.