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2. COMMISSIONER'S AWARD OF EXCELLENCE NOMINATION FORM

   Please submit completed nomination forms to the County Commissioners Office by the first day of the month for the following month's award. 

4. Nominee's First & Last Name*
5. Job Classification / Title*
7. Department*
8. Division
10. When did this Accomplishment Occur?*
12. Nomination Criteria*

    1. Safety
    2. Productivity

    1. Loss Prevention
    2. Customer Relations

    1. Valor
14. Nominee Accomplishments/Event. Explain specifically the nominee's accomplishments that best describe why this employee should receive the Commissioner's Award of Excellence. The following questions are a guide in helping to complete your description.*
16. How does this accomplishment impact the County with regards to money savings? (Describe dollar amount, hours, compensation etc.) *
18. Was this accomplishment self-initiated? *
20. Please describe how this accomplishment was outside of this person's job description?*
22. Please enter the following information about yourself.
24. Name*
25. Date*
27. Department*
28. Email*
30. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
32. Electronic Signature*
Leave This Blank:


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

    This field is not part of the form submission.

36. Submit Submit and Print

* indicates a required field