NOMINATION FORM
(To be accomplished by Company Official)

1.      PERSONAL DATA
Name:_____________________________________________________________
Company:__________________________________________________________
Position/Department:______________________________________________
Effective Date of Employment:_____________________________________
Home Address:_____________________________________________________
Work Telephone No.:______________ Home Telephone No.:_____________
Nationality:________________________ Sex:_________ Age:___________
Birthdate:_____________________ Birthplace:_______________________
Father’s Name:____________________________________________________
Occupation:_______________________________________________________
Mother’s Name:____________________________________________________
Occupation:_______________________________________________________

2.      JOB DESCRIPTION OF NOMINEE
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3.      Why do you believe your nominee deserves to be one of the 10 Most Outstanding Workers of CEZ for 2002?

     (Please expound on the following judging criteria).

 

3.1.   Attendance & Punctuality:
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3.2.   Quantity of Work:
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3.3.   Quality of Work:
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3.4.   Cooperation:
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3.5.   Initiative

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3.6.   Work Attitude
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3.7.   Discipline

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4.  What exemplary, outstanding, extra-ordinary and/or performance

   your nominee has done or undertaken that has contributed to the

   Company’s savings and profits, safety, enhanced employee’s morale

   and production, and promoted a friendly environment workplace, as

   well as security and safety? (please use back sheet if necessary)

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I, ____________________________, the _____________________________

             Name of Company Official                                  Position

of ____________________________ hereby attest to the veracity of

            Department/Division

the above information.

  ___________________________         _________________________

           Signature                              Date

(To be accomplished by a fellow worker)

5.      As a fellow worker, how can you support your claim that your company’s nominee should be one of the 10 Most Outstanding Workers of CEZ 2002? (Expound on the nominee’s attendance and punctuality, quantity and quality of work, cooperation, work attitude, discipline and the exemplary and/orextra-ordinary performance or deed that has contributed to the company’s savings and profit, safety, enhanced employee’s morale and production and promoted a friendly environment).

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___________________________           __________________________

Signature over Printed Name                     Position

                         _______________

                               Date