Employee Nominee Form

404 H. Street, Eureka, CA 95501. Phone (707) 442-5785 - Fax (707) 445-2656

EMPLOYEE OF THE MONTH NOMINEE FORM

* All fields are required

Date:	07/30/2010 01:30 PM
What is your name?*
What is your email address?*
Name of the employee nominated:*
Please explain what the employee has done or which professional qualities were exhibited during this month:*