Application for AFDO Achievement Award

This nomination must be submitted by February 1, 2007 to be considered for the current year's award.

Criteria for Nomination

The AFDO Achievement Award can be given for one or more specific achievements, or for a documented sustained high level of performance.

He or she must be in his on her first five years of service as a sanitarian, inspector, investigator, milk specialist, food specialist, radiological health inspector, consumer product safety inspector, or similar regulatory position.
He or she must be a field person; that is, one who goes out of the office to make inspections a significant portion of his or her working time.
The winner must be employed by a federal, state, county, or municipal regulatory agency, which has a least one employee as a member of AFDO. However, the candidate for the award need not be a member of AFDO.

AFDO Achievement Award Application Form

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Date of Nomination: // For the year ending December 31, 2006

Candidate's
Full Name:

Home
Address:

Title:

Agency:

Department:

Agency
Address:

Telephone Number
Home: Office:

E-mail Address:

Date of entry into regulatory work: / /

Years on the job:

Percentage of time spent in field work (based on 40-hour week): %

Description of Duties:

Narrative Portion

Describe the one or more specific achievement(s) or sustained high level of performance for which this candidate is being nominated

Name of an individual in candidate's agency who is a member of the Association of Food and Drug Officials:

Nominated by:

Signature:

The winner of this aware will be invited to attend the AFDO Awards Banquet at the Annual AFDO Conference in June. Attendance is not mandatory for receiving the award. After completing this form, highlight the form and print on 8 1/2" x 11" paper, or request a form from Gene Blake, Chairman and mail or fax this form with the narrative portion not exceeding one page.

This award was underwritten by a gift for this purpose by Kenneth A. Silver.

For additional information please contact Eugene A Blake at eblake@ci.concord.nh.us

Send application to

Eugene A. Blake, Chairman
AFDO Awards Committee
City of Concord Health Services
37 Green Street
Concord, NH 03301
Phone: 603-230-3639
FAX: 603-225-8586
E-mail: eblake@ci.concrd.nh.us

SUBMIT BY FEBRUARY 1, 2007

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Page updated August 20, 2006