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SERVICE RECOGNITION AWARD
1
Town of Vienna, Virginia
NOMINATION FORM
Employee Name:
Division:
Position:
Nominator:
Check
One
Nominee must meet one of the following criteria. A complete description of the event or action must be
given.
Accomplishment of a Noteworthy Deed: Demonstrating exceptional courtesy, responsiveness or
assistance when interacting with Town residents and other members of the public. Such actions are
typically nonrecurring, one-time accomplishments; for example, assisting a stranded motorist;
providing special assistance to a senior citizen on trash collection day; or replacing an overturned
barricade after normal working hours
.
Cite the specific noteworthy deed, how this went beyond
regular job duties and reflected positively on the Town.
Extraordinary Performance: An action that had a specific beginning and end and had an identifiable result
or outcome; for example, consistently put in extra time and effort to respond to the growing demands on
an office; successfully coordinated or completed
a major project; completed a difficult work project ahead
of schedule or under adverse work conditions; exhibited high levels of productivity over an extended period
of time; or consistently provided extra assistance to citizens and/or fellow employees.
Cite specific
examples of repeated excellence; describe how they went beyond regular job duties and how these
actions reflected positively on the Town.
Problem Resolution: Solved an extraordinary problem or achieved a significantly difficult goal
. State the
problem or goal, how it was solved or achieved, and describe the impact that this had on the Town.
Innovation: Successfully implemented an innovative idea where outstanding results were identifiable
.
Describe the idea, the action taken to achieve it and the results, including cost savings, if known.
Acceptance of special assignments beyond the parameters of normal duties.
Explicitly detail with
specific examples how the actions went beyond the normal job duties.
Other actions deemed as notable by the supervisor and department head.
In defining these notable
actions, cite the specific action or actions, how these actions went beyond regular job duties and
reflected positively on the Town.
JUSTIFICATION
Date or Dates of Event:
Describe why the act or
event is outside of the
employee’s normal job
responsibilities.
Justification must be
sufficient to meet
criteria. Attach additional
pages if needed.