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***This is our moment!***

**2009 CHICAGO FEDERAL EMPLOYEE OF THE YEAR AWARDS**

**NOMINATION FORM - INSTRUCTIONS**

**INSTRUCTIONS**

The basic instructions for preparing nominations appear in the
Nominations Booklet for the 2009 Chicago Federal Employee of the Awards
Program.

Submit an ***original*** and ***three*** copies of this form for each
nominee. Do not submit ***ANY*** other attachments.

Nominations should be typed, single spaced, with a double space between
paragraphs.

The Criteria/Selection Subcommittee can consider only the data shown on
pages of this nomination form. Please do not submit ***ANY***
attachments or work samples because they will not be considered.

In the narrative, please describe the nominee's accomplishments in
relation to the following three factors: **[Job Competence, Impact, and
Special Efforts]{.underline}**. See the Criteria Booklet for further
information about the factors. Be specific and address the elements
described in the factors in your discussion of the nominee's
accomplishments. *Describe each factor separately*.

**[Mail Nominations to:]{.underline}** **Kathryn Fontaine - FEOYA 2009**

**U.S. Department of Labor OASAM**

**230 S. Dearborn Street RM 1026**

**Chicago, IL 60604**

**NOMINATION FORM**

**2009 CHICAGO FEDERAL EMPLOYEE OF THE YEAR AWARDS**

**Submit one original and 3 copies**

Full Name of the
Nominee:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Please provide a PHONETIC spelling of the complete
name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Position/Title/Grade:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Location
(Agency/Name/Address):\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Nominee's Telephone
Number:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**PRINT AGENCY NAME BELOW EXACTLY HOW IT SHOULD APPEAR ON NOMINEE
RECOGNITION**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Nominee to be considered for**:

(Please check one - refer to category definitions in the Criteria
Booklet, the FEOYA committee reserves the right to change the nominee to
a different category if the original category's criteria is not met)

\[ \] Category I: \[ \] Category VII:

Outstanding Professional Employee Outstanding Trade & Crafts Employee

\[ \] Category II: \[ \] Category VIII:

Outstanding Supervisory Employee Outstanding Community Service Employee

\[ \] Category III \[ \] Category IX:

Outstanding Program Specialist Employee Outstanding Public Contact
Employee

\[ \] Category IV: \[ \] Category X:

Outstanding Law Enforcement Employee Outstanding Team

\[ \] Category V:

Outstanding Technical or Program Support Employee

\[ \] Category VI: \[ \] Category XI:

Outstanding Secretarial/Clerical Employee Outstanding Law Enforcement
Team

> NOMINATION FORM - Cont.

Full Name of
Nominee:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

***Please type name EXACTLY as you wish it to appear on recognition
certificate.***

**FACTOR I - JOB COMPETENCE:**

**FACTOR II - IMPACT (Not necessary for Category VIII/Community
Service)**

**NOMINATION FORM - Cont.**

Full Name of
Nominee:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**FACTOR III - COMMUNITY SERVICE/TEAM WORK (Necessary only for
Categories VIII, X, and XI. See Nomination Booklet):**

**FACTOR IV - SPECIAL EFFORTS:**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of Agency or Installation Head Title

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\*Signature\* of local Agency/Installation Head Telephone Number

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Nomination Coordinator Telephone Number

**\*\*MUST BE SIGNED BY AGENCY/INSTALLATION HEAD\*\***

**\*\*SUBMIT ORIGINAL AND THREE COPIES\*\***