Examination Ethics and Honesty Award UniAbj
For Staff and Public Servants only
Name of Nominator
*
First Name
Last Name
E-mail
*
example@example.com
Application Date
-
Month
-
Day
Year
Date
Phone
*
-
Area Code
Phone Number
Nominee's Name
*
First Name
Last Name
Nominee's Phone Number
*
-
Area Code
Phone Number
Nominee's Department/Occupation
*
Staff Id
*
For how Long have you Noticed This
one year
two years
three years
other
Consistency in Difficult Situation
Yes
No
Mostly
Rearly
Reason for Nomination (with confirm-able evidence)
*
Referee 1
*
Referee's Name, Department, Phone Number
Referee 2
*
Referee's Name, Department, Phone Number
Referee 3
Referee's Name, Department, Phone Number
Submit
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