SPOT BONUS PROGRAM	NOMINATION FORM

Nominee’s Information
Name:	Date:
Telephone Number:	Office Location:
Length of Employment at FSSA:	Job Title:
Supervisor’s Name:	PS ID #:	(e.g., A234567)
Nominator’s Information
Name:	Title:
Telephone Number:	Office Location:
What is your relationship with the employee you are nominating? (select one)	Amount: (up to $1,000)
Co-Worker Employee’s Supervisor Other (please explain):
Nomination Details
How has the nominee provided exceptional or outstanding customer service or exhibited extraordinary effort to support FSSA?
Please provide specific examples that illustrate outstanding performance. If possible, please attach documentation, third party testimonials and other tangible evidence to support the nomination.
Briefly explain how FSSA and its customers benefit from the work of the nominee.
Approvals; route to FSSA Human Resources when complete
SUPERVISOR	DATE
DIVISION DIRECTOR	DATE
SECRETARY/DESIGNEE	DATE
HR RECEIVED	DATE