Employee of the Month Nomination Survey

INSTRUCTIONS: Please respond to the following questions in complete and specific terms that are related to the nomination. Give precise examples of this person's level of performance which qualify them to be nominated as the Department of Social Services Employee of the Month. Refer to DSS Policy 2-205 (Employee Recognition Programs) for additional information.

Any state employee may nominate another employee for their department for this award. Department directors, deputy department directors, division directors and deputy division directors (including acting and official) are not eligible for the Employee of the Month Award.

Nominee's Name(Required.)

Nominee's Division(Required.)

Nominee's County(Required.)

Nominee's Work Address

Nominee's Job Title

Why are you nominating this person?
Please be descriptive, add stories and elaborate. There is no character limit.(Required.)

Describe the amount of initiative and extra effort that went into this service.
Please be descriptive, add stories and elaborate. There is no character limit.(Required.)

Additional Comments