Employee of the Quarter Nomination

LECOM Health CMH Employee of the Quarter

Award Nomination Form

I am pleased to nominate:(Required)

First and last name of nominee

First Last

Job title:(Required)

What is the nominee's job at Corry Memorial Hospital?

Department:(Required)

For what department does the nominee work?

Nominated by:(Required)

What is your name?

First Last

Your email:(Required)

Please provide your email address so we can contact you if we have any questions about your nomination.

Values

Nominees should demonstrate our values:

Integrity

Teamwork

Health & Wellness

Excellence

Stewardship

Innovate

Respectful

Welcoming

Competent and Compassionate Staff

How does the nominee demonstrate our values?(Required)

Describe and give specific examples of how this person demonstrated our values listed above.

How did this person add to our success?(Required)

Explain how this person added to the success of Corry Memorial Hospital.

Do you have any additional comments?

(Optional)

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