Core Value Award Program Nomination Form printable pdf download

Core Value Award Program

Nomination Form

Date: ____________

Nominee’s Name: ___________________________________________

Date of Employment: _________________

Department: _____________________ Job Title: ______________________ Supervisor: _______________________

The Employee CORE VALUE AWARD Selection Committee wants to identify nominees for this honor. Your opinion will be invaluable

in helping the committee to make a selection for the Employee of the Month.

FOR SUPERVISORS ONLY: The CORE VALUE AWARD Selection Committee needs to know if you support the nomination.

Yes _____ I support the nomination

No _____ I do not support the nomination

If NO, please indicate the reason: ________________________________________________________________________________

___________________________________________________________________________________________________________.

Please take a few minutes to give the committee examples of how ______________ has demonstrated one of the Core Values of UK

Hospital. Circle the appropriate CORE VALUE

Sense of Urgency:

Responds in a timely manner to exceed customer expectations

Teamwork:

Works in a cooperative and collaborative manner to achieve our goals

Accountability:

Accepts the responsibility and outcomes for decisions and actions

Innovation:

Creates and uses knowledge in new and different ways to continuously improve services

Respect:

Values the uniqueness and work of each individual and treats everyone with dignity

Please provide specific examples of behavior or actions to validate the nomination:

___________________________________________________________________________________________________________

Signatures:

For Supervisors:

Please provide the name of

1) a co-worker __________________________________

2) a person from another department _________________________________

Supervisor: __________________________________________

Date: ___________________________

Reference: ___________________________________________

Date: __________________________

Please return within 30 days to: Judi Dunn, HIL, C111 UK Hospital 0293 email: jdunn1@email.uky.edu Phone: 323-5061

Core Value Award Program Nomination Form