Strictly Business
Nomination Form

*Nominee's First Name
*Nominee's Last Name
*Nominee's Title
*Nominee's Company
*Company Address
*Company City
*Company State
*Supervisor's First Name
*Supervisor's Last Name
*Supervisor's Title
*Supervisor's Phone
*Supervisor's Email
Please describe the employee's job duties and responsibilities.
Has the employee overcome any challenges in the workplace? Yes No
If yes, please describe.
In what areas has the employee grown and excelled on the job?
Why do you consider this person a success story?
Please provide detailed examples of the following attributes and rate between 1-5.
1 = unsatisfactory, 2 = fair, 3 = good, 4 = very good, 5 = outstanding
1. Reliability 
Rating:
Comments:
2. Job Performance 
Rating:
Comments:
3. Initiative 
Rating:
Comments:
4. Interpersonal Skills 
Rating:
Comments:
Any additional comments?
JVS would like to have your permission to use your comments for marketing purposes. (We will not publish any comments that refer to your employee without their explicit permission.)
I hereby grant JVS permission to publish my comments for marketing purposes.

Questions? Email us or call 415-782-6216.
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JVS is a non-profit, non-sectarian 501(c)(3) corporation. JVS is a Beneficiary of the Jewish Community Federation,
and is accredited by the Commission on Accreditation of Rehabilitation Facilities.