Employee Referral Program Payment Approval Form

To  be completed by the hiring manager or the direct supervisor of the referred new hire.

Employee name:__________________________________________________

Department:________________________  Job title: ______________________

Referred employee:  _________________  Hire date: _____________________

Department:  _______________________  Job title: ______________________

Amount of Bonus:
☐ $[amount] for full-time employee.
☐ $[amount] net for part-time or temporary employee.

Approximate Date of Bonus Payment*:
Full-time:  _____________________(minimum 90 days from hire date)
Part-time or temporary:  _____________________  (minimum 30 days from hire date)
*payment will be made to the referring employee on the next payroll date following eligibility.

Supervisor approval:  _____________________________  Date:  _____________
(supervisor of referred employee)

Note to supervisor: If the referred employee does not complete the introductory period or meet the minimum days of service, please contact the payroll department to cancel this referral payment.

                        * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

For Payroll Use

Date received: ____________________

Amount: $ ________________________

Bonus payment paid on payroll ending: _______________________

Account charged to: ______________________________________

Completed by:  __________________________________________