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Corry Memorial Hospital
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
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Information About the Nominee
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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