Nominee For The Hall Of Fame Award Form - Missouri Department Of Public Safety
Download a blank fillable Nominee For The Hall Of Fame Award Form - Missouri Department Of Public Safety in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Nominee For The Hall Of Fame Award Form - Missouri Department Of Public Safety with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2MISSOURI DEPARTMENT OF PUBLIC SAFETY
MISSOURI PUBLIC SAFETY AWARDS
PUBLIC SAFETY AWARDS
HALL OF FAME AWARD
P.O. BOX 749
NOMINATION
JEFFERSON CITY, MO 65102
This form should be used only for nominations for the Hall of Fame Award, presented to a senior or retired
Missouri public safety professional for a career that serves as a model of exceptional courage, service, fairness
and compassion. Type or print clearly. Complete all sections.
NOMINEE'S NAME:
NOMINEE’S AGENCY NAME:
NOMINEE'S HOME ADDRESS:
NOMINEE'S PHONE (INCLUDE AREA CODE):
HOME:
CELL:
NOMINEE'S E-MAIL ADDRESS:
The Hall of Fame award is presented to a senior or retired public safety professional in recognition of an exemplary
career of service to the State of Missouri. To be considered for the Hall of Fame Award, the nominee’s career must
serve as a model of exceptional courage, service, fairness and compassion. Those nominated for this award will have a
distinguished career history of service above and beyond normal expectations and have devoted their talents, time
and resources to improving the safety and security of Missouri’s citizens. Nominations may be made by a statewide
association or organization representing a public safety discipline.
For a candidate to be eligible to receive the Hall of Fame award, the completed nomination form must be sent to the
Mo. Dept. of Public Safety, P.O. Box 749, Jefferson City, MO 65102 no later than March 31, 2018.
Nominations must be signed by the Chief Executive or Director of the nominating public safety agency, statewide
association or organization representing a public safety discipline.
To be considered, the nomination must include:
1.
A copy of this completed form.
2.
Official reports and documentation, including previous awards (with supporting materials), media reports,
and letters of support demonstrating exceptional courage, service, fairness and compassion over a career.
Please note that these materials may be subject to disclosure; therefore, please make all redactions
necessary to maintain the confidentiality of information that may compromise an ongoing law enforcement
investigation or that is otherwise required by law to be kept confidential.
3.
Statements by officers, witnesses and/or individuals having personal knowledge of the facts surrounding the
candidate's achievements.
A person nominated for the Hall of Fame Award cannot be nominated in the same year for any other Missouri
Department of Public Safety award or the Medal of Valor.
NOMINATING OFFICIAL'S NAME AND TITLE:
NOMINATING AGENCY:
ADDRESS:
TELEPHONE (INCLUDE AREA CODE):
NOMINATOR’S EMAIL ADDRESS:
DISCLOSE ANY CURRENT OR PAST RELATIONSHIP BETWEEN THE NOMINEE AND THE NOMINATING AGENCY:
As Chief Executive or Director of nominating agency, association, or organization, I certify that the nomination
file has been completed in accordance with the above directions and hereby recommend the above named
individual to receive the Hall of Fame Award.
RECOMMENDING SIGNATURE:
DATE:
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Lea-pst - Safety Telecommunicator Training Paperwork Checklist Form - New Mexico Department Of Public Safety Training Center
Legal
Form Cdl-3a - Application For Military Skills Test Waiver - Texas Department Of Public Safety
Business
Form Pi-1 - Application For Licensure - Oregon Department Of Public Safety Standards And Training
Legal
Related Categories
Parent category: Legal