Core Value Award Program Employee Nomination Form

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Core Value Award Program
Nomination Form
Date: ____________
Nominee’s Name: ___________________________________________
Date of Employment: _________________
Department: _____________________ Job Title: ______________________ Supervisor: _______________________
The Employee CORE VALUE AWARD Selection Committee wants to identify nominees for this honor. Your opinion will be invaluable
in helping the committee to make a selection for the Employee of the Month.
FOR SUPERVISORS ONLY: The CORE VALUE AWARD Selection Committee needs to know if you support the nomination.
Yes _____ I support the nomination
No _____ I do not support the nomination
If NO, please indicate the reason: ________________________________________________________________________________
___________________________________________________________________________________________________________.
Please take a few minutes to give the committee examples of how ______________ has demonstrated one of the Core Values of UK
Hospital. Circle the appropriate CORE VALUE
Sense of Urgency:
Responds in a timely manner to exceed customer expectations
Teamwork:
Works in a cooperative and collaborative manner to achieve our goals
Accountability:
Accepts the responsibility and outcomes for decisions and actions
Innovation:
Creates and uses knowledge in new and different ways to continuously improve services
Respect:
Values the uniqueness and work of each individual and treats everyone with dignity
Please provide specific examples of behavior or actions to validate the nomination:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Signatures:
For Supervisors:
Please provide the name of
1) a co-worker __________________________________
2) a person from another department _________________________________
Supervisor: __________________________________________
Date: ___________________________
Reference: ___________________________________________
Date: __________________________
Please return within 30 days to: Judi Dunn, HIL, C111 UK Hospital 0293 email: jdunn1@email.uky.edu Phone: 323-5061
Core Value Award Program
Nomination Form
Date: ____________
Nominee’s Name: ___________________________________________
Date of Employment: _________________
Department: _____________________ Job Title: ______________________ Supervisor: _______________________
The Employee CORE VALUE AWARD Selection Committee wants to identify nominees for this honor. Your opinion will be invaluable
in helping the committee to make a selection for the Employee of the Month.
FOR SUPERVISORS ONLY: The CORE VALUE AWARD Selection Committee needs to know if you support the nomination.
Yes _____ I support the nomination
No _____ I do not support the nomination
If NO, please indicate the reason: ________________________________________________________________________________
___________________________________________________________________________________________________________.
Please take a few minutes to give the committee examples of how ______________ has demonstrated one of the Core Values of UK
Hospital. Circle the appropriate CORE VALUE
Sense of Urgency:
Responds in a timely manner to exceed customer expectations
Teamwork:
Works in a cooperative and collaborative manner to achieve our goals
Accountability:
Accepts the responsibility and outcomes for decisions and actions
Innovation:
Creates and uses knowledge in new and different ways to continuously improve services
Respect:
Values the uniqueness and work of each individual and treats everyone with dignity
Please provide specific examples of behavior or actions to validate the nomination:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Signatures:
For Supervisors:
Please provide the name of
1) a co-worker __________________________________
2) a person from another department _________________________________
Supervisor: __________________________________________
Date: ___________________________
Reference: ___________________________________________
Date: __________________________
Please return within 30 days to: Judi Dunn, HIL, C111 UK Hospital 0293 email: jdunn1@email.uky.edu Phone: 323-5061

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