Employee Referral Bonus Form

This form MUST be submitted to the Human Resources Department BEFORE we receive an application from the potential employee. This form will be valid for 60 days from the date of submission. If your referral is not hired withing 60 days you will need to submit a new form.

Information of Pipestone Employee:

Your Work Location:

First Name: Last Name:

Information of Person Being Referred:

First Name: Last Name:

Please explain how you know the person you are referring:

List 5 major qualities that this person has that would contribute to them being an excellent employee:


The applicant must put your name on the application in order for you to be eligible for the Employee Referral Bonus Program. Rehires are not eligible. You must be an active PIPESTONE employee at the time the bonus is paid. All Employee Referral Bonus payments are subject to management’s discretion.

By typing your name below, you certify that all the information entered is true and correct to the best of your knowledge. Also, you understand that any omissions, misleading statements or incorrect answers made by you may void this form.

Type your Full Name: Date(mm/dd/yy):
Email Address:

Please click the submit button only once when submitting this form.