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Staff Manual Guide 3113.4, Attachment A

FORMAT FOR FDA COMMENDABLE SERVICE AWARD

Prepare an information sheet. The instructions in parentheses describe the information to be entered. Do not exceed one page.

(Actual size 8 1/2" x 11")

NOMINATION FOR FDA COMMENDABLE SERVICE AWARD

1. Name and organization of nominee:
(Use name exactly as it should appear on certificate. Include any doctoral degree used. For a group nomination, indicate the name of the group.)

2. Title, series, and grade of current position:
(Example - Consumer Safety Officer, GS-0696-12)

3. Brief statement of current duties:

4. Length of Government service:

5. Length of service with the Department and with FDA:

6. Listing of previous honors and awards:

7. Brief summary of education:

8. Brief summary of work experience:

9. Proposed citation: (Twenty-five (25) words or less summarizing the service or achievement which serves as the basis for this nomination.)

*NOTE: When a group is nominated, items 2 and 4 through 8 may be omitted, but a complete and accurate alphabetical listing of the names of each member of the group is to be attached indicating Mr., Mrs., Ms., Miss, D.V.M., M.D., Ph.D., etc.; for each person. The brief statement of current duties for group nominations (#3) may be indicated as the duties of the group rather than for each individual.

Prepare a narrative justification (single-spaced). The instructions in parentheses describe the information to be entered. Do not exceed three pages and do not attach written testimonials or endorsements.

(Actual size 8 1/2" x 11")

NARRATIVE STATEMENT

(Describe the employee's achievement or distinguished service, showing clearly the manner in which the nominee has met the award criteria. This statement should include sufficient detail to provide reviewing and advising boards with enough information to effectively evaluate the nominee's contribution. Some points to include, if applicable, are: impact of the achievement on Agency mission, function, or activity affected; level of effectiveness before and after improvement actions were taken; results obtained by the nominee's actions, including any quantifiable evidence of improvement; and, degree of ingenuity, innovation, or exceptional skill demonstrated by the nominee.)