Employee Recognition Program

Nomination Form

Name of Nominee:	Division/District:
Your Name:	Division/District:
Signature	Date
District/Division Awards: NDOT Excellence in Achievement and Performance Award NDOT Excellence in Leadership Award On the Spot Recognition NDOT Excellence in Customer Service Award Loader Competition NDOT Excellence in Mentorship Award Shop/Yard/Construction Office of the Year
Agency Level Awards: Emergency Public Assistance Good Samaritan	Informal Awards: Community Service Employee Recognition Panel Members
Description:

Approved Not Approved

(Division/District Panel’s Decision)	ER Chair Signature	(Date)

Approved Not Approved

(Division Head/District Engineer’s Decision)	DH/DE Signature	(Date)

NDOT Form 304c, February 22