Professional Staffperformance Bonus Request

HR54

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Professional StaffPerformance Bonus Request

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This form should be used to request and approve the payment of a Performance Bonus for a Professional staff member.
Refer to MelbournePolicy Library: for relevant policy information.
All fields and sections marked with an asterisk (*) are mandatory. / Once this form has been completed it must be printed, signed, approved and sent to your Local HR Representative.
Enquiries regarding this form can be made to your Local HR Representative: y6x.

1. Employee Information*

Employee No. / Position Number
Family Name / Given Names
Organisation Unit

2. PERFORMANCE BONUS*

Amount of Bonus recommended / %of salary, or $ / Effective Date
Basis for recommendation*
Themis Accounts String:† / ------
† Please specify account only if different from assignment charging.

3. supervisor Details and declaration*

The Supervisor must certify that the employee has achieved a rating of ‘outstanding’ as part of their last performance feedback discussion or has met set pre-determined targets as negotiated in the PDF and linked to a one-off payment.
In the case of pre-determined targets, the prior approval for such an arrangement must be attached to this form.
I certify that a rating of ‘outstanding’ has been achieved by this employee in their last PDF, or;
I certify that pre-determined targets for this employee’s performance have been met and copies of the
prior approval for this arrangement are attached.
I acknowledge that a maximum of one such payment per annum is permitted.
Signature of Supervisor
(Level 1 Delegation) / Name
Date

4. advice and SIGNATURE of staff member*

In most cases, payment will be made through normal fortnightly salary payments. For staff members who have pre-nominated to salary package additional lump sum payments (in accordance with the University Policy Manual: ), please tick the box below to ensure that this payment is paid directly into your superannuation fund.
Further details are available at .
I have pre-nominated to salary package additional lump sum payments in accordance with the University Policy Manual: . Please pay this bonus directly into my superannuation fund.
Signature of Employee / Date

5. HEADapproval*

The recommendation is / Approved
Not Approved / Signature of Head of Dept / Equivalent
(Level 2 Delegation)
Name
Date
Once approved by the Head, forward to Local HR if supported, or return to Supervisor if rejected.

privacy information

Information collected on this form will become part of employees’ employment record.
It will be stored securely and only used or released in accordance with theUniversity’s privacy policy which is available from .

FINANCE AND EMPLOYEE SERVICES, UNIVERSITY services use only

Processed by / Date / Pay Period
Validated by / Stamp

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