Salary, Job, Location Change

(Use for promotions, transfers, and location changes)

EO 52.1)

Employee Information / lAST fIRST mIDDLE
Name: / EMPLOYEE #:
Current Location: Region#: Division#: Home Office other
Department#: National Store#: brand TELEworker? Yes No
Section I: CSD Change/
Status / new csd (MM/DD/YY): New status: full-time (ft)
break in service Part time salaried with benefits (ps)
credit for past service Part time hourly with benefits (pb)
new hsd (mm/dd/yy): Part time without benefits (pt)
Section II:
Performance Review
(PA 26.1) / Rating: / Date of Review (MM/DD/YY):
Review Type: Performance Review Interim Update Performance Improvement
Next Performance Review Date: / Next Review Type:
Section III:
Salary
Change / Effective Date:
(MM/DD/YY) / Please include the month and year of the effective date. Effective date MUST be the 1st or 16th of the month for salaried managers and all staff. / Is this the region/department’s common review date? Yes No
ANNUAL / HOURLY
For lump sum increases, use Special Check Request Form. / Pay Category / Amount / New Salary / Amount / New Rate
Base / Current Rate of Pay / $ / XXXXXXX / $ / XXXXXX
Merit Increase / Increase Amount / $ / $ / $ / $
Band to Band / Promotion (One Band to Another) / $ / $ / $ / $
Demotion (One Band to Another) / $ / $ / $ / $
In-Band and Other Adjustments / Adjustment to Minimum / $ / $ / $ / $
Adjustment for Development/Skills Enhancement / $ / $ / $ / $
Internal Equity Adjustment / $ / $ / $ / $
External Equity Adjustment / $ / $ / $ / $
Other Adjustment / $ / $ / $ / $
Salary Reduction / $ / $ / $ / $
Section IV:
Job Change / New Job title code (Use 5 digit code) :
Authorization Signature change form Yes No / Effective Date (MM/DD/YY):
Reason (Check One): Promotion Demotion Lateral Move ADJUST FOR DEV/SKILLS ENHANCEMENT
Section V:
Location Change / Location Information:
New State/Site #: 0/ New Region #: New Department//National Store #:
Mail Code: Employee ACTUAL Work Location (City/State):
Effective Date of Transfer: Please include the month and year of the effective date.
(MM/01/YY)or(MM/16/YY) Effective date MUST be the 1st or 16th of the month.
Location Change Reason:
Store to Store
Store Relocation/ Rebuild / Dept. to Dept.
Temporary Ownership / Region to Region
State Site Change / Sale of Store / Acquisition to McD
Development
Teleworker in new job/location?  Yes No
Section VI:
Supervisor Information / Employee’s Direct Supervisor’s Name: ______Employee # ______
Is employee a staff employee and a supervisor of others? If yes, complete “REPORTING STRUCTURE CHANGE FORM STAFF ONLY” (HR07)
Approved by / Approver signature / pRINTED NAME / Date / Telephone #
(Signature must be on the Service Center Authorized Signature Listing)
Submitted by
requestor signature / pRINTED NAME / Date / Telephone #

Instructions for Completing the Salary, Job, Location Change Form
(For your use only)

Performance Review / The Review information must be completed in order to process any pay change.
Job Change / A listing of Most Common Job Title Codes can be obtained by calling the Service Center Fax-Back Service and entering code #3868.
Salary Change
Examples / The payroll system requires information in a certain order and form. What must be entered is the total new salary or rate of pay after the increase or decrease. Here’s a step by step:
  • Fill in the current salary or rate of pay.
  • Then work down the form and fill in the increase or decrease amount for the first pay category where a change is occurring.
  • Add the amount to the current salary or rate of pay and fill in the new salary or new rate of pay. If you are giving both a merit increase and a promotional increase, each increase should be calculated based on the current rate of pay as shown below.
  • Continue down the form. The last entry in the new salary or new rate of pay column should reflect all the changes and be the final salary or rate of pay.
FOR EXAMPLE: The calculations for a $25,000 salary, 4% merit and 5% promotion are:
$25,000 plus $1,000 merit ($25,000 x .04) = $26,000 – (Put $1,000 in amount under merit increase, $26,000 in new salary box next to it)
$26,000 plus $1,250 promotion ($25,000 x .05) = $27,250 – (Put $1,250 in amount next to promotion, $27,250 in new salary box next to it)
ANNUAL / HOURLY
Pay Category / Amount / New Salary / Amount / New Rate
of Pay
Base / Current Rate of Pay / $ 25,000 / $
Merit Increase / Increase Amount / $ 1,000 / $ 26,000 / $ / $
Band to Band / Promotion (One Band to Another) / $ 1,250 / $ 27,250 / $ / $
Demotion (One Band to Another) / $ / $ / $ / $
In-Band and Other Adjustments / Adjustment to Minimum / $ / $ / $ / $
Adjustment for Development/Skills Enhancement / $ / $ / $ / $
Internal Equity Adjustment / $ / $ / $ / $
External Equity Adjustment / $ / $ / $ / $
Other Adjustment / $ / $ / $ / $
Salary Reduction / $ / $ / $ / $

Pay Period Begin and Payroll Close Dates — Staff and Restaurant Managers

(excluding DM Managers)

Effective Dates / All salary, job and location changes must be effective with the pay period begin date as shown in the chart below.
Payroll close is the date by which all payroll changes (e.g. New Hire, Salary Change, Job Change) must be received by the ServiceCenter in order to be reflected in the next paycheck.

PAY PERIOD BEGIN DATE*

/ PAYROLL CLOSE DATE** /
CHECK DATE
12/16/12 / 12/20/12 / 12/31/12
01/01/13 / 01/04/13 / 01/15/13
01/16/13 / 01/18/13 / 01/31/13
02/01/13 / 02/07/13 / 02/15/13
02/16/13 / 02/18/13 / 02/28/13
03/01/13 / 03/07/13 / 03/15/13
03/16/13 / 03/21/13 / 03/29/13
04/01/13 / 04/05/13 / 04/15/13
04/16/13 / 04/19/13 / 04/30/13
05/01/13 / 05/06/13 / 05/15/13
05/16/13 / 05/17/13 / 05/31/13
06/01/13 / 06/06/13 / 06/14/13
06/16/13 / 06/20/13 / 06/28/13
07/01/13 / 07/05/13 / 07/15/13
07/16/13 / 07/22/13 / 07/31/13
08/01/13 / 08/05/13 / 08/15/13
08/16/13 / 08/22/13 / 08/30/13
09/01/13 / 09/05/13 / 09/13/13
09/16/13 / 09/20/13 / 09/30/13
10/01/13 / 10/04/13 / 10/15/13
10/16/13 / 10/21/13 / 10/31/13
11/01/13 / 11/07/13 / 11/15/13
11/16/13 / 11/21/13 / 11/29/13
12/01/13 / 12/05/13 / 12/13/13
12/16/13 / 12/19/13 / 12/31/13
01/01/14 / 01/06/14 / 01/15/14

* All Salary, Job and Location changes must be effective with the pay period begin date as shown.

**Payroll close is the date by which all payroll changes (e.g., New Hire, Salary Change, Job Change) must be

received by the ServiceCenter in order to be reflected in the next paycheck.

Location Changes /
  • All forms must be signed by an Authorized signer, who has the appropriate authorization level.
  • Please provide actual work location; city and state to ensure correct tax deductions.
  • Please provide mail code to ensure payroll check or check advice is mailed to the correct location. Code 402 may be used for mail to home only if employee works in a remote location.

Teleworker / Provide current teleworker status (Yes/No) in the Employee Information section.
Provide new teleworker status (Yes/No) in the Location Change section.

Please forward this completed form and all required attachments (if applicable) to: FORM 3862 12/13/12

McDonald’s Service Center, Dept. 238, McDonald’s Corporation, 2111 McDonald’s Drive, Oak Brook, Il, 60523
Telephone #: (877) 623-1955 Fax #: (630) 623-5027 E-Mail Address: