DOM-Employee of the Month
Month (*)
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Name of Nominee (*)
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#Years Nominee Employed by UAB-DOM(if you know)
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Job Title of Nominee (*)
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Phone # of Nominee(xxx-xxx-xxxx)
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Please provide your information:
Your Name (*)
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Your Email address (*)
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Your Phone #(xxx-xxx-xxxx)
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Submission Date (*)
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GUIDELINES: Please specify why your nominee should be selected as Employee of the Month, by providing clear evidence of excellence for each of the following five criteria below. Please provide specific examples for each criterion so the Selection Committee will understand why the person you are nominating should be DOM Employee of the Month!
JOB PERFORMANCE (5 Points)- Especially conscientious by doing more than is required in performing his/her job; efficient, dependable, knows and follows UAB DOM policies; prompt and regular work attendance, and effective use of work time
Job Performance (*)
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BEHAVIOR/ATTITUDE (5 points) – Knows the value of and demonstrates courtesy and tact in all contact with co-workers and patients alike. Projects a positive image, sincere, honest, and open-minded. Motivates and works well with his/her peers. Demonstrates Service Excellence.
Behavior/Attitude (*)
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INITIATIVE/CREATIVITY (5 points) – Exhibits ingenuity and resourcefulness in their service to the Department of Medicine and to UAB
Initiative/Creativity (*)
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LOYALTY/DEDICATION (5 points) – Goes the extra mile to serve the DOM; has made some special or extra contribution in any way whether it is time, effort, money, active involvement in committees, fund-raising campaigns, health fairs or other activities for the DOM and for UAB.
Loyalty/Dedication (*)
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EMBODIES DOM STAFF MISSION (5 points) – see attached DOM Staff Mission Statement and www.uabmedicine.org/amc21
Embodies DOM Staff Mission (*)
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Total 25 points possible. Thank you for taking the time to recognize your co-worker. Please submit the form.
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Department Chair Seth Landefeld, MD, Appointed to U.S. Preventive Services Task Force
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