Fillable Form Ad-287-2 - Recommendation & Approval Of Awards printable pdf download

It is the policy of the Department to ensure that consideration for awards is made without regard to race, color, national origin, religion, sex, age, marital

status, disability or other nonmerit factors.

U.S. DEPARTMENT OF AGRICULTURE

CASE NO. (Personnel Use Only)

RECOMMENDATION & APPROVAL OF AWARDS

NOTE: For group awards, attach list of group members. Show data in Items 2 - 9, and award amount for each payee.

1. AGENCY

2. NAME OF EMPLOYEE (Last, first, middle initial)

3. SOCIAL SECURITY NO.

4. POSITION TITLE

5. PAY PLAN-SERIES/GRADE/STEP

6. ORGANIZATION AND LOCATION

7. PERIOD COVERED FOR AWARD (mm, dd, yy)

8. ACCOUNTING CODE

From:

To:

9. IF AWARD APPROVED, MAIL CHECK TO:

(ADDRESS)

SALARY CHECK ADDRESS

OTHER (Specify address):

10. LIST AWARDS OR QSI'S IN THE PAST 52 WEEKS (Specify type of award, amount received, and effective date.)

11. CITATION: SUMMARIZE EMPLOYEE'S CONTRIBUTION IN 25 WORDS OR LESS. (This language will appear on the employee's certificate.)

EMPLOYEE IS BEING RECOGNIZED FOR:

COMPLETE THE APPROPRIATE AWARD SECTION

12. TYPE OF RECOGNITION RECOMMENDED (check one)

EMPLOYEE SUGGESTION

EXTRA EFFORT

SPOT AWARD

TIME OFF AWARD **

OTHER *

OR INVENTION *

AWARD *

KEEPSAKE AWARD

GAINSHARING AWARD

* Attach a description of the contribution or patent notification being recognized and the resulting benefits to the Government.

** Attach a description if the contribution exceeds the moderate benefits.

13.

NO. OF

14.

TOTAL AWARD

15.

ESTIMATED FIRST YEAR SAVINGS

MEASURABLE

PERSONS

(Give dollar

TOTAL DOLLAR

BENEFITS SCALE

amount / hours,

AMOUNT/HOURS

or value of item)

BASED ON:

VALUE OF BENEFITS

APPLICATION

(Check

NONMEASURABLE

approp.

BENEFITS SCALE

box)

16. TYPE OF RECOGNITION RECOMMENDED (check one)

PERFORMANCE BONUS

QUALITY STEP INCREASE *

AWARD *

Certification: I certify, by my signature in the Recommendation & Approval section below, that the

employee's position description and the performance standards for the positions were thoroughly

reviewed prior to submission of this recommendation; that the employee's performance is outstanding;

and that the performance is characteristic and is expected to continue in the future.

* Attach a copy of employee's latest performance rating of record. Also, attach a justification statement, if required.

17. DATE OF LAST PROMOTION

18. DATE OF LAST WITHIN GRADE INCREASE

19.

AMOUNT RECOMMENDED FOR

PERFORMANCE BONUS AWARD

RECOMMENDATION AND APPROVAL

20. RECOMMENDING INDIVIDUAL (Signature)

DATE

21. REVIEWING OFFICIAL (Signature)

DATE

TITLE:

22. APPROVING OFFICIAL (Signature & Title)

DATE

PERSONNEL USE ONLY

25. TO: (Grade & Step)

23. AGENCY

24. DATE

QUALITY

26. NEW SALARY

27. RATE

28.

PAY RATE DETER-

CODE/POI

EFFECTIVE

MINANT CODE

STEP

INCREASE:

29. PERSONNEL OFFICIAL (Signature & Title)

DATE PROCESSED

I certify that the proposed action

is in compliance with statutory

and regulatory requirements

*U.S. GPO: 1977-516-741/85276

Form AD-287-2 (7/94)

This form was electronically produced by Elite and modified

Clear Form

by USDA/ARS/ITD using InForms software.

Form Ad-287-2 - Recommendation & Approval Of Awards

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