Nomination Form
Name of Nominee
Department Name
Employee ID Number of Person Completing Nomination Form
Would you like to remain anonymous? (This means your name will not be included in the materials used to promote the Employee of the Month.)
No
Yes
Key Basic Ratings
Community
5 - Exceptional
4 - Above Average
3 - Average
2 - Needs Improvement
1 - Poor
Purpose
5 - Exceptional
4 - Above Average
3 - Average
2 - Needs Improvement
1 - Poor
Integrity
5 - Exceptional
4 - Above Average
3 - Average
2 - Needs Improvement
1 - Poor
Joy
5 - Exceptional
4 - Above Average
3 - Average
2 - Needs Improvement
1 - Poor
Nomination Narrative