Johns Hopkins Health System Corporation & The Johns Hopkins Hospital

BAKER-KING AWARD NOMINATION FORM

Employee Name:_______________________________________________  

Social Security Number:_________________________________________

 

Job Title:_____________________________________________________

Department:___________________________________________________

In completing the following, please give detailed responses and cite specific examples of performance supporting your nomination.

1.                  Describe the employee’s job performance and specifically discuss the following:  job knowledge, suggestions for improving work methods, supervision required, willingness to take on additional assignments and level of judgment exercised.

2.                  Describe the employee’s work habits and specifically address the following:  attendance, relationships with co-workers and interaction with patients, visitors and other departments.

3.                  Provide specific examples where the employee has demonstrated outstanding performance.

4.                  Describe other factors, which support this nomination.  Copies of letters of commendations from patients, visitors, or staff may be attached.

Signature: _____________________________ Signature: _____________________________

Department/Administrator                                              Manager/Supervisor

Department:____________________________             Department:____________________________

Telephone number ______________________ Telephone number ______________________       

For Selection Committee use only:

________ Accepted

________ Undecided