Bridge Health Employee Nomination Form

OUR VISION

Partnering with individuals throughout their journey to health, healing, and recovery.

OUR MISSION

Our purpose is to partner with individuals and communities to improve lives by providing services that can lead to transformation.
Nominator Information*

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Relationship to the nominee (e.g. coworker, supervisor, etc.)
Nominee Information*

First NameLast Name
Nominee's current job title
Nominee work location*
Month Nomination Submitted:*
How does this individual exemplify and live out the mission and vision of Bridge Health?
Reason for nomination: Check all that apply*

Effort that was above and beyond job responsibilitiesDemonstrated extraordinary leadership and/or teamworkProvided encouragement to inspire someone elseContributed exceptionally to a projectReacted effectively to an urgent situation/crisis intervention
How does this individual exemplify and live out the mission and vision of Bridge Health? (Check all that apply):*

AdabtabilityAuthenticityAutonomyBalanceCollaborationCompassionCommunicationCommunityContributionCreativityDependabilityDeterminationDiversityEmpathyEnthusiasmFairnessFlexibilityImpactInnovationLeadershipLoyaltyOptimismParticipationPatienceQualityReliabilityRespectTeamworkTime ManagementTrustworthiness
Nomination Criteria

Please choose AT LEAST THREE of the below examples and give a detailed description for each example. You may describe more than three but at least three must be filled in for the nominee to be considered.
Effort was "above and beyond" job responsibilities...
Demonstrated extraordinary leadership and/or teamwork skills...
Inspired others to do their best; offered techniques and/or unexpected time and energy to assist others with no expectation of recognition...
Contributed exceptionally to a project...
Reacted positively to an urgent situation or individual in crisis...
Are there any additional reasons you would like to nominate this person?
Briefly explain what this individual has done to make them an outstanding employee and worth of this recognition:*
Once you complete this form, click on the "Submit" button below. This will then email you a copy of the submission, which is also emailed to the Bridge Health Culture Committee.
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