Employee of the Month Nomination Form - HR Homepage

1 Employee of the Month Nomination form Department of Human Resources 1246 West Campus Road | Lawrence, KS 66045 | 785-864-4946 | Fax 785-864-5790 | Page 1 of 2 The deadline for submitting Nomination forms to Human Resources is the first day of September, December, March or June. If the 1st falls on a weekend the deadline will be the following Monday. Nominations are then reviewed and voted upon the following Month by the Recognition Committee. In the event the nominated Employee is not selected as a winner for next quarter the Nomination remains active for a second review round. The Nomination form is the primary source of information for review purposes. For this reason specifics about the nominee s contributions and accomplishments are vital to the process.

2 In addition, a representative of the committee will contact the supervisor or manager of the unit for supplemental information. Other documentation and/or letters of support may be submitted with the Nomination by sending them to To be eligible a nominee must have a half-time or greater appointment in a regular, ongoing position at the time of Nomination with one (1) year of service at KU or a recognized Affiliate. Assistance in completion of the Nomination form may be received by contacting HR at 864-4946. Nominee Full Name: _____ KU Start Date: _____ Employee Type University Staff Affiliated Corporation Nominee s Supervisor Name: _____ Phone: _____ Co-Worker(s) / Contact Person(s) for Reference(s) Name(s): _____ Department: _____ Nominator Name: _____ Department: _____ Campus Phone: _____ Email: _____ Employee of the Month Nomination form Department of Human Resources 1246 West Campus Road | Lawrence, KS 66045 | 785-864-4946 | Fax 785-864-5790 | Page 2 of 2 Briefly describe the nominee's job duties: * Describe in detail the nominee's dedication and interest in getting the job done, his or her personal and professional strengths, and the quantity and quality of his or her work.

3 * Describe in some detail the nominee's adaptability to circumstances and creative problem solving ability. Include examples of exceptional and/or significant contributions during the past 12 months: * Describe in detail the nominee's ability to interact/work well with others: * Describe in detail any special service to fellow employees, the university community, or to other individuals, organizations, or communities: * Are there any other ways in which this nominee has distinguished himself or herself? If yes, please explain. *