Thomas S. Green Public Service Awards Nomination Form - Worcester Regional Research Bureau

2019 NOMINATION FORM

(Please return no later than Friday, February 22, 2019)

The Thomas S. Green Public Service Awards honor municipal and public school employees who have made outstanding contributions to public service. The awards publicly recognize the efforts of Central Massachusetts public servants who illustrate:

Exceptional competence and efficient handling of all assigned responsibilities
Enthusiastic performance of tasks above and beyond the call of duty
Cooperative, helpful, and friendly attitude toward the public and fellow employees
Community involvement outside the scope of job-related responsibilities

Nominees should have a minimum of five years employment with the municipality or school district and should be actively employed at the time of the nomination. Department and division heads are not eligible for the award. Candidates nominated in previous years who did not receive the award may be re-nominated.

Please use the form below to submit your nomination, or download the form here, and mail to: Worcester Regional Research Bureau, 500 Salisbury Street, Worcester MA 01609.

Nominee Information

Name of Nominee * First Last
City/Town of Employment: *
Department: *
Position: *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone *
Email *

Nominator Information

Name of Nominator * First Last
Affiliation *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone *
Email *

Letters and Criteria

In order to ensure a thorough review of nominees, The Research Bureau and the Thomas S. Green Public Service Awards Review Committee requests broad insight into the nominee.
Letter(s) of Support: Using the area below, please describe the nominee’s role and explain specifically how he or she has performed those job responsibilities in an exceptional manner. One additional letter of support from supervisors, peers, and members of the public and/or documentation of outstanding work is required. Multiple letters are highly encouraged. To include multiple letters of support, please email them to
*
Additional Letters Microsoft Word (.doc & .docx) and PDF accepted

Criteria

The Committee would like insight into the capacity and character of the nominees. Below, we offer various criteria for evaluation. We do not expect that nominators will be able to evaluate nominees on all criteria. Please provide a considered review of your proposed nominee’s qualities in those areas that you feel competent. Feel free to coordinate on this review with others who may be able to provide additional insight into the nominee.
Job Performance/Competence *
Does the nominee excel at his/her position and is he or she fully competent at assigned responsibilities?
Efficiency *
Is the nominee efficient with time, resources, and effort to complete responsibilities?
Responsiveness *
Is the nominee responsive to public requests for assistance, including phone calls and emails?
Professionalism *
Does the nominee exhibit professionalism with the public and fellow employees?
Initiative *
Is the nominee self-motivated, taking initiative when dealing with issues and/or opportunities?
Innovation *
Is the nominee innovative, able to identify new, better means for accomplishing responsibilities?
Adaptability *
Is the nominee open to change and able to embrace new policies, responsibilities, situations, and leadership?
Dedication *
Does the nominee go beyond the normal job requirements to assist the public or colleagues with extraordinary tasks?
Collaboration *
Is the nominee a team player and able to work with diverse individuals and groups?
Enthusiasm *
Does the nominee exhibit enthusiasm for his/her job and responsibilities?
Involvement *
Is the nominee involved in the community through volunteer opportunities, participation in local events, or support for local causes?

Verification

Please enter any two digits with no spaces (Example: 12) *
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Thank you very much for your support of the Thomas S. Green Public Service Awards and your commitment to good government in Central Massachusetts. If you have any questions about the Awards or the role of The Research Bureau, please see our website at www.wrrb.org or contact us at .

NOTE: More information, including past recipients, may be found at www.wrrb.org. This application may be referred to the nominee’s department head/supervisor for additional information and support.

2019 T.S. GREEN AWARDS