MMD-MOP-01-05
MOST OUTSTANDING ELECTRICAL PRACTITIONER IN VARIOUS FIELDS NOMINATION/ APPLICATION FORM Date : ______________________ TO THE AWARDS COMMITTEE: We/ I nominate herein named person as Outstanding Electrical Practitioner for the year 2014 in the field of: < < < < < < <
> Consultancy > Corporate Management > Education > Government & Government-Controlled Corporation > Manufacturing/Industry > Project Management /Electrical Contracting > Research and Development
2” x 2” White Background 1. Full Name : __________________________________________________________________ Photo Family Name First Name Middle Name 2. Age (at the time of nomination) : __________________________________________________ 3. IIEE Chapter Affiliation : ________________________________________________________ 4. Home Address : _______________________________________________________________ 5. Present Position/ Title : _________________________________________________________ Length of Time : _________ Organization/ Company : _______________________________ ___________________________________________ Length of Service : ______________ Address & Tel. No. : ___________________________________________________________ ____________________________________________________________________________ 6. Education :
BACHELOR
MASTERS
DOCTORATE
School :
___________________
____________________
___________________
Degree :
___________________
____________________
___________________
Year :
___________________
____________________
___________________
7. Professional License, if any :
8. Membership Grade :
< > PEE < > REE < > RME Others: < > __________ < > __________ < > Regular Member < > Life Member < > Senior Member < > Fellow
Year : __________ Year : __________ Year : __________ Year : __________ Year : __________
9. Specific qualities or achievements of the nominee which are outstanding/ significant. Attach brief description of these in separate sheets if necessary. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ____________________________________ (use additional sheets if necessary) 10. Nominator VOUCHER : We hereby certify that herein nominee is personally known to us to be of good reputation and moral character; that, we also know of no conviction/ s or pending case/ s against him; and that we know him to be fully qualified for the award. A. BY CHAPTER RESOLUTION : Chapter Number Chapter President
: :
___________________________________________________ ___________________________________________________ Printed Name & Signature
B. BY INDIVIDUAL ENDORSEMENTS : b.1.
Name : PEE/ REE No.:
_________________________ _________________________
___________________ Signature
b.2.
Name : PEE/ REE No.:
_________________________ _________________________
___________________ Signature
b.3.
Name : PEE/ REE No.:
_________________________ _________________________
___________________ Signature
Note : The above voucher, by Chapter or by Individuals (colleagues in the profession), is a mandatory requirement. The Awards Committee will not deliberate on any nominee who has not been properly nominated and vouched for. (Nomination/ Application Form was revised during the Selection and Awards Committee Meeting on July 2, 2005 and was approved by the Board of Governors during the Regular Board Meeting on July 22, 2005.)