National Employ the Older Worker Week

NC Department of Health and Human Services

Division of Aging & Adult Services

2101 Mail Service Center

Raleigh, NC 27699-2101

North Carolina Employ the Older Worker Week

September 21-25, 2015

Victor W. Marshall

Older Worker Employer

Award Nomination Form

This award recognizes public/private sector companies and host agencies (one award for each category) that either provide training or have make a concerted effort to employ mature workers age 55 and older. Award winners will be announced during Older Workers Week and recognized at the 2015 Employ the Older Worker Week Celebration that will be held on Wednesday, September 30th at 11:30 AM in Raleigh.

Complete this form by Thursday, September 10th. Submit your nominations to:

Reena Shetty via one of the following formats:

1) U.S. Mail:

NC Division of Aging and Adult Services

2101 Mail Service Center

Raleigh, NC 27699-2101

2) Fax:

919-715-0868

3) Email:

Name of Organization: __________________________________________________

Check the appropriate category for your nominee:

_______Public _______Private ______Host Agency-SCSEP/Title V

Indicate how your nominee exemplifies each of the following award criteria. Each of the criteria carries equal weight in the selection process.

Please describe benefits the nominee offers to persons 55 years of age and older (i.e., sick/vacation time, life/health insurance, flex time, job sharing, retirement options, upgrading/training, family leave and other).

Please type or print:

____________________________________________________________________________

Please describe how the nominee has demonstrated a commitment to hire and retain older workers in the workplace (i.e., flextime, job sharing, family leave, percentage of older workers in the workplace and utilization of older worker programs in the community).

Please type or print:

____________________________________________________________________________

Please describe any special qualities exhibited by this organization, which makes them worthy of this award.

Please type or print:

____________________________________________________________________________

Nominee’s Phone: ( ) ______________________

Business Address:_____________________________________________________

City: _______________________________________________ Zip Code: _________

Email:________________________________________________________________

Nominator: ___________________________________________________________

Nominator’s Phone: ( ) _________________________

Email:________________________________________________________________

Nominations received after September 10, 2015 will not be eligible for consideration.