Diversity Award Nomination Form

Please Note:
Any County department, unit and/or employee is eligible for nomination. Self-nominations will not be accepted.

Nomination Type (and/or)

County Department/Unit

County Employee

Department/Unit Being Nominated

Employee Being Nominated

Name of Department Head

Department Where Employee Works

Phone Number of Department Head/Contact Person

Telephone Number of Employee

Selection Criteria Requirements

Submit a completed nomination form and up to two-page typed summary, using the attached Selection Criteria Questionnaire, that provides a description of how the nominee has demonstrated this commitment in one or more of the following areas:

Accomplishments, leadership, and service in support of diversity, inclusion, and equal opportunity.
Nominee's achievements in creating or enhancing an inclusive work environment.
Participation in any County EEO Program activity.
Participation in any department effort designed to promote and embrace the spirit of diversity, inclusion, and equal opportunity within the County.

Selection Criteria Questionnaire

The recipient will have demonstrated a commitment to enhancing and advancing the spirit of diversity, inclusion, and equal opportunity within the County workforce.

Has the Nominee created or enhanced an inclusive work environment? If so, please explain and give specific examples.

Has the Nominee demonstrated a commitment to enhancing and advancing the spirit of diversity, inclusion, and equal opportunity through participation in any County EEO program activity? If so, please explain and give specific examples.

Submitted By

Department

Telephone Number

Signature

I hereby confirm that the information I am providing is true and correct to the best of my knowledge.

Signed By

Date