Employee Suggestion Form printable pdf download

Employee Suggestion Form

DO NOT WRITE IN THIS BLOCK

Please read the other

NEW JERSEY

SUGGESTION NUMBER:

side carefully before

STATE EMPLOYEE AWARDS PROGRAM

completing this form.

DEPARTMENT(S) CHARGED:

Employee

Type or print clearly

ACKNOWLEDGED:

Suggestion Form

in blue or black ink

SUBJECT AND CODE:

and answer all the

questions.

1. YOUR NAME

6. OFFICE PHONE

4. DEPARTMENT AND ADDRESS

NUMBER

2. SOCIAL SECURITY NUMBER

7. TODAY’S DATE

5. HOME ADDRESS (Number, Street, City, State and Zip Code)

3. YOUR JOB TITLE

8. SIGNATURE

9. IS THIS YOUR FIRST SUGGESTION?

10. METHOD OF SUBMISSION

11. ARE YOU INTERESTED IN TIME OFF IN LIEU OF CASH?

OPTION 1

OPTION 2

YES

12. DESCRIBE YOUR SUGGESTION BRIEFLY.

13. EXPLAIN PRESENT CONDITION, METHOD, OR PRACTICE.

14. EXPLAIN SPECIFICALLY HOW YOUR SUGGESTION WILL SAVE OR IMPROVE CONDITIONS AND WHAT SHOULD BE DONE.

GIVE A DETAILED ACTION PLAN AND ATTACH ADDITIONAL PAGES IF NEEDED.

15. LIST SAVINGS IN TIME, MATERIALS, SUPPLIES, OR OTHER BENEFITS.

DPF-73 REVISED 7-01 n\forms

Employee Suggestion Form