Commissioner’s Outstanding Leadership Medal Nomination Form

Nominee details

Name

Rank/Designation

Telephone

Work Unit

Work Location

Nominator details

Name

Rank/Designation

Telephone

Work Unit

Work Location

Select your service area

Select service area below

NTPF

PSEU

Nomination details that describe the nominees distinguished service

The Commissioner's Outstanding Leadership Medal is awarded to individuals within the Northern Territory Police Force (NTPF) to recognise outstanding leadership by encompassing principle values to the highest standard.

To support the nomination, please complete the sections below providing information on how the nominee demonstrates outstanding leadership under each nomination criteria.

Ethical Practice

Respect

Accountability

Impartiality

Diversity

Collaboration

Nominees direct supervisor details

Name and title

Nominees line manager details

Name and title

Referee1

Name

Rank/Designation

Telephone

Work Location

Referee2

Name

Rank/Designation

Telephone

Work Location

Acknowledgement and Signature

By submitting this form, I acknowledge that I have declared any association with the nominee which would be or perceived to be a conflict.

Nominator signature

Sign above

Date

Attachments (Please upload referee statements)

Maximum 5 files.
800 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.