Healthy Workplace Nomination Form

How did you hear about the UnitedHealthcare Healthy Workplace Awards? (You may choose more than one):
Advertisement in TBJ, Mohawk Valley Business Journal or Greater Binghamton Business Journal paper
Advertisement on the CNYBJ website
Email
BizEventz website
My health-plan representative or broker
Other (please specify)

NOMINATION SECTION

Nominee First Name:

Nominee Last Name:

Nominee Email Address:

Nominee Phone:

Company Name:

Street:

City:

State:

Postal Code:

2010 Number of Employees:

2010 Gross revenue:

Description of company:

Local Attorney (Company/Contact/Phone)::

Local Bank (Branch/Contact/Phone)::

Nominator (required if other than nominee)

Nominated by (name):

Title:

Company:

Email-Nominator:

Phone number:

Address:

City/State/Zip:

Written Section:

Attach a separate sheet with information (300 words max) detailing nominee's qualifications, quantitative business accomplishments, and community or non-profit activities.

Consider how this candidate has made a positive contribution to the profession and how they've demonstrated outstanding leadership skills, such as enterprise risk-management, at their organization.
Especially note nominee's crisis-management skills in regard to helping his/her company weather the recession.
Provide a resume or other document that details nominee's career history and significant achievements.
Attach Support Docs./Recommendations

:

Please fill out the nomination form completely and accurately. This form will be used in the selection process. Photocopies are acceptable. If the nomination form is not filled out, nominee will be disqualified. (A resume does not replace the nomination form.) A word document is available by calling. Complete form and return to mnesher@bizeventz.com.

A panel of judges will review each nomination, rank each category, and select 2-3 finalists for each category. The winners will be announced at the Financial Executive of the Year Luncheon on June 14, 2011. Judges are in no way liable for the honorees chosen.

If your applicant becomes a finalist:

You (the nominator) will be notified within 2 weeks after the nomination deadline.
Your honoree will be recognized at the Financial Executive of the Year Luncheon with an award and as a special guest of BizEventz and our sponsors.
Your honoree will be publicized in the Central New York Business Journal and in ads promoting the event.

If your applicant is not chosen:

The nominator (you) will be notified within 2 weeks after the nomination deadline. If the nominator would like BizEventz to notify the person on the nomination form, BizEventz will do this per request, via a letter.

UnitedHealthcare Healthy Workplace Awards NOMINATION FORM

UnitedHealthcare Healthy Workplace Awards

NOMINATION FORM