Form Ad-287-2 - Recommendation & Approval Of Awards
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1It 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:
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.
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