Bonus Request Form

Name of employee to receive bonus ________________________________ Banner ID ____________________ Department ___________________ Supervisor making bonus request __________________________________ A bonus is a special one-time, after-the-fact, lump-sum payment to a staff member to reward extraordinary performance. Bonus eligibility requirements include an overall performance rating of “meets all” or higher on employee‟s last performance appraisal. Please indicate employee‟s last performance appraisal rating: ___________________. Gross amount of one-time, lump-sum bonus payment recommendation*: Please describe the extraordinary accomplishments of the employee that occurred outside the boundaries of his/her expected job performance. _____________________________________________________________

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(Note: Approvals must be obtained by the functional VP and HR before informing employee of bonus. HR will notify supervisor when bonus has been approved.) VP Approval __________________________________ Date ___________

HR Approval __________________________________ Date ___________

$

Account # Charged _______________________________________ *Bonuses must be paid at the gross amount and are taxable to the

employee. Bonus payments will not be „grossed up‟ to avoid tax

payments. Additionally, bonuses are not eligible for benefits.