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2. This form should be filled out by the Department Designee during each step of the Referral Bonus Process
4. Today's Date*
   Today's Date
6. Please fill this information out for the Department Designee
8. First Name*
9. Last Name*
11. Email Address*
15. Please fill this information out for the Employee eligible for bonus
17. First Name*
18. Last Name*
20. Email Address*
22. Name of the Employee Hired

    Please type first and last name of the employee hired. 

24. Please select the appropriate step in the Referral Bonus Process (Hired, Probation Release, 2 year bonus, etc.)
26. Seasonal/Variable
    -- Select One --One-Time Referral Bonus ($500)
27. Non-Sworn/Regular
    -- Select One --Hired Bonus ($500)Probation Release ($500)
29. Police Officer
    -- Select One --Hired Bonus ($500)Academy Completion ($500)Probation Release ($500)
30. Certified Police Officer
    -- Select One --Hired Bonus ($1000)Probation Release ($1000)2 Year Bonus ($1000)
31. Lateral Police Officer
    -- Select One --Hired Bonus ($2500)Probation Release ($2500)2 Year Bonus ($2500)
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field