Patricia Anne Brennan Award Nomination Form

Nominee details

Name

Rank/Designation

Telephone

Work Unit

Work Location

Nominee direct supervisor details

Name and title

Nominee line manager details

Name and title

Nominator details

Name

Rank/Designation

Telephone

Work Unit

Work Location

Select your service area

select service area below

Police

Fire and Rescue

Emergency Service

Public Sector

Nomination Details

The Patricia Anne Brennan Award recognises an individual employee or volunteer, regardless of gender recognising their significant contribution to women in the NTPF or NTFES.

To support the nomination, please complete the sections below providing information on how the nominee has met each criteria.

1. Demonstrates commitment by supporting, mentoring and developing women in NTPF or NTFES to maximise their potential.

2. Fosters and promotes initiatives that recognise the potential of women in NTPF or NTFES.

3. Demonstrates leadership and is a positive role model.

4. Demonstrates integrity, respect, equity and diversity.

5. Supports and encourages women in the NTPF or NTFES to strive for excellence.

6. What makes the nominee’s contribution outstanding.

Other Comments

Referee 1

Name

Rank/Designation

Telephone

Work Unit

Work Location

Referee 2

Name

Rank/Designation

Telephone

Work Unit

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

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Date

Attachments (Please upload referee statements)

Maximum 5 files.
800 MB limit.
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