EMPLOYEE RECOGNITION PROGRAM NOMINEE

INFORMATION FORM

Name of person nominated:

Name	Title
Department	Campus Phone

Name of person making the nomination:

Name	Title
Department	Campus Phone

References: List at least one, but no more than three references who support this nomination. These references should be notified that they may be required to furnish a letter of recommendation. The person making the nomination should submit a letter addressing the criteria with the nomination application. . PLEASE NOTE: The nomination must be made or supported by the supervisor. The supervisor must submit a letter of support at time of nomination. Persons listed as reference are not required to submit a letter at this time and will only be asked to do so if needed.

Name	Title
Department	Campus Phone
Name	Title
Department	Campus Phone
Name	Title
Department	Campus Phone

For use by Office of Human Resources only:

Two year requirement met?
Yes
No
Did supervisor supply letter?
Yes
No
Service Date
Years of Service
Date received
Date sent to committee for review
Reason for hold
Date additional information requested
Of Whom
Date additional information received
Total Score

11/08

OIT

2009-09-30

SIUE