Team Member Information Sheet
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TEAM INFORMATION
P U B L I C S E R V I C E A W A R D O F
Team Name __________________________
Team Contact _____
______________________
(please identify one team member as the Team Contact)
Name of Team Member ____
____________________________________________________________________________
Position Title: __________________________________________________________________________________________
Department: ____________________________________________
Division: ___________________________________
Work address: _________________________________________________________
Postal Code: __________________
Telephone: _________________________
Fax: ____________________
email: _____________________________
Signature: ___________________________________________________________________________________________
I consent to stand for nomination and to participate in the Public Service Award of Excellence. My name and photo may be used in
any internal and external communication that will showcase the recipients and/or nominees of the award.
Supervisor
Name: _______________________________________________________________________________________________
Position Title: __________________________________________________________________________________________
Work address: _______________________________________________________
Postal Code: __________________
Telephone: _________________________
Fax: ____________________
email: _____________________________
Name of Team Member ____
____________________________________________________________________________
Position Title: __________________________________________________________________________________________
Department: ____________________________________________
Division: ___________________________________
Work address: _________________________________________________________
Postal Code: __________________
Telephone: _________________________
Fax: ____________________
email: _____________________________
Signature: ___________________________________________________________________________________________
I consent to stand for nomination and to participate in the Public Service Award of Excellence. My name and photo may be used in
any internal and external communication that will showcase the recipients and/or nominees of the award.
Supervisor
Name: _______________________________________________________________________________________________
Position Title: __________________________________________________________________________________________
Work address: _______________________________________________________
Postal Code: __________________
Telephone: _________________________
Fax: ____________________
email: _____________________________
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Parent category: Business