Facilities Management Employee Recognition Award

Nomination Form

The Employee Recognition Award is your opportunity to tell other people about the outstanding efforts coworkers accomplish

for customers, colleagues, and the community-at-large, and to ensure that those efforts are recognized. If you know of

someone that has accomplished something special, just fill in this form and send it to the nominated employee’s

supervisor. Completed forms will be forwarded to the Facilities Management Human Resources & Training

department. Nominees will be considered for a Certificate of Recognition and may be eligible for a gift card, a monetary

award, and/or recognition leave. Please refer to Directive 135C.

I would like to Nominate:

NAME

ORACLE ID #

COST CENTER/ORG

FM DIVISION

_____________________________________________________________________

(If nominating more than 5 people, please attach the list on a separate piece of paper)

Description of Specific Efforts or Services:

(attach additional sheet if necessary)

__________________________________________________________________________________________

___________________________________________________________________________________________________

Nominator’s Name (Print)

Nominator’s Signature

Date

___________________________________________________________________________________________________

Supervisor’s Name (Print)

Supervisor’s Signature

Date

Recommended Award:

Non-Monetary award (to be coordinated with the FM HR Director)

Monetary Award – Amount: $ _______ (Level ___ Award)

Recognition Leave – Amount: _______ (Level ___ Award)

Extraordinary Contributor Form (HR to complete if checked)

_________________________________________________________________________________________________

Director’s Name (Print)

Director’s Signature (Required)

Date

_________________________________________________________________________________________________

Donald E. Sundgren

Chief Facilities Officer (Print)

CFO’s Signature (Required for Level II & III Awards)

Date

Revised 2/10

Facilities Management Employee Recognition Award - Nomination Form