Staff Information Form

NOMINEES FORM

Name:

Date of Birth:

Date of birth doesn't match the age entered.

Age:

Staff ID:

Grade:

Place of Work:

Number of Years In Service (Excluding National Service):

You do not meet the minimum years of experience requirement for this category.

Years of service doesn't match your first appointment date.

Phone:

Email:

Select Region:

Nominees DDNS:

Date of First Appointment (mm/dd/yy):

Type of Application:

Award Name:

Number of Years in Managerial Position: 10 years min for senior and 5-9 min for junior

You do not meet the minimum years requirement for this category.

Number of Years as a Nurse Educator: Must be min of 5 years

You must have at least 5 years of experience as an educator.

Number of Publications: Min 5

You must have at least 5 publication.

Number of Citations: Min 5

You must have at least 5 citations.

Number of Years as a Preceptor: 5 years min

You must have at least 5 years as a preceptor.

Number of Years as a Leader in Military Facility: 2 years min

You must have at least 2 years of leadership in military facility.

Number of Years as a Leader in Police Facility: 2 years min

You must have at least 2 years of leadership in police facility.

Appointment Letter:

NMC Certificate:

CV:

Project / Innovation file:

Explain Your Project or Innovation in not more than 500 words. (One Page): 0 / 500 words

Statement of Motivation:

Note: Only shortlisted nominees will be contacted for interviews.