2000 examiner application - StarChapter
New Examiner Application Form2020 Award Cycle2020 Mid-Atlantic Alliance for Performance Excellence Board of ExaminersThis form is fill-in enabled. Please complete all sections and submit it to bbitner@. The attached Recommendation Form is required for candidates who have not previously served as a MAAPE Examiner. Recommendations may be submitted electronically or mailed to the Mid-Atlantic Alliance for Performance Excellence office.Your application must be sent no later than FRIDAY, JANUARY 17th , 2020(Recommendation Form may be sent separately but must be RECEIVED by January 24th , 2020) TEL: 717-737-Title (Mr., Ms., Mrs., Dr.): First Name: FORMTEXT ????? M.I.: FORMTEXT ?????Last Name: FORMTEXT ?????Employer: FORMTEXT ?????Title: FORMTEXT ?????Preferred Mailing Address: FORMTEXT ????? Home FORMTEXT ????? WorkStreet: FORMTEXT ?????City, State, Zip: FORMTEXT ?????FedEx Delivery Address (no P.O. Box): FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Primary PhoneSecondary PhoneFaxE-mail Address: FORMTEXT ????? NAICS code(s) (see enclosure) most relevant to expertise: 1. FORMTEXT ????? 2. FORMTEXT ????? 3. FORMTEXT ?????If you have been a Mid-Atlantic Alliance for Performance Excellence Examiner previously, list the year(s): FORMTEXT ?????Are you an examiner for any other type of award program? FORMTEXT ????? Yes FORMTEXT ????? NoIf yes, please specify which award(s): FORMTEXT ?????ExperienceFor the positions you have held during your professional career, please provide the information requested. Describe your last three positions or the last 10 years, whichever is longer. List in order, beginning with the most recent. Use additional pages if necessary. See enclosed list for NAICS Codes.Current Employer: FORMTEXT ?????Number of Employees: FORMTEXT ?????Complete address of Employer: FORMTEXT ?????Dates of service: FORMTEXT ?????to present FORMTEXT ?????full-time FORMTEXT ?????part-timeJob Title: FORMTEXT ?????Number of employees supervised: FORMTEXT ?????Supervisor’s Name: FORMTEXT ?????Title: FORMTEXT ????? NAICS Codes of Employer: FORMTEXT ?????Type of products or services: FORMTEXT ?????Parent company (if applicable): FORMTEXT ?????Experience in performance improvement associated with this job: FORMTEXT ?????Employer: FORMTEXT ?????Number of Employees: FORMTEXT ?????Complete address of Employer: FORMTEXT ?????Dates of service from: FORMTEXT ?????to: FORMTEXT ????? FORMTEXT ?????full-time FORMTEXT ?????part-timeJob Title: FORMTEXT ?????Number of employees supervised: FORMTEXT ?????Supervisor’s Name: FORMTEXT ?????Title: FORMTEXT ????? NAICS Codes of Employer: FORMTEXT ????? Type of products or services: FORMTEXT ?????Parent company (if applicable): FORMTEXT ?????Experience in performance improvement associated with this job: FORMTEXT ?????Employer: FORMTEXT ?????Number of Employees: FORMTEXT ?????Complete address of Employer: FORMTEXT ?????Dates of service from: FORMTEXT ?????to: FORMTEXT ????? FORMTEXT ?????full-time FORMTEXT ?????part-timeJob Title: FORMTEXT ?????Number of employees supervised: FORMTEXT ?????Supervisor’s Name: FORMTEXT ?????Title: FORMTEXT ????? NAICS Codes of Employer: FORMTEXT ????? Type of products or services: FORMTEXT ?????Parent company (if applicable): FORMTEXT ?????Experience in performance improvement associated with this job: FORMTEXT ?????Please indicate your level of ability to evaluate applications in the seven Categories of the Baldrige Excellence Framework by placing an X in the appropriate column:NoneVery LittleProficientExpertLeadership FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Strategy FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Customers FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Measurement, Analysis & FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Knowledge ManagementWorkforce FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Operations FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Results FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Please indicate your ability to evaluate applications in the following sectors by placing an X in the appropriate column:NoneVery LittleProficientExpertManufacturing FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Service FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Small Business FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Health Care FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Education (P-12) FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Post-Secondary Education FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Public Sector FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Please indicate your level of skills in the following areas by placing an X in the appropriate column:NoneVery LittleProficientExpertManagement FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Analysis of results FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Written communication FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Improvement strategies FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Leadership FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Interpersonal relations FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Education or training FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Education and Training BackgroundPlease list the name and location of post-secondary institution(s), major(s), attending dates and degree(s) received. Include significant formal training in performance improvement. FORMTEXT ?????Written and Oral CommunicationDescribe your accomplishments in both written and oral communication by citing examples of your most recent and/or relevant experience. FORMTEXT ?????Team ExperienceProvide a brief description of your experience on teams and why you are an effective team member. FORMTEXT ?????Publications/Major Reports/Major Speeches Relevant to Performance ImprovementList the title and citation of your most recent publications or reports first (limit to five examples). List the title and audience of major speeches during the past two years. FORMTEXT ?????Outreach Activities, Achievements, Recognition and/or Professional Affiliations FORMTEXT ?????Describe in 100-300 words why you would like to become a member of the Mid-Atlantic Alliance for Performance Excellence Board of Examiners. FORMTEXT ?????Examiner Preparation WebinarsA series of four webinars has been scheduled to help examiners complete the prework required for MAAPE's in-class training. Webinars will be held on the following dates:Jan 23rd - 9am to 10:30amJan 30th– 9am to 11amFeb 7th- 9am to 11:30amFeb 14th-9am to 11am Please block your calendars so that you can participate in ALL FOUR webinars. In-class trainingAll examiners must complete the prework and participate in the three-day training course. Please indicate your first and second choice of 2020 training dates by marking “1” and “2” in the fields below. Mar 3 thru Mar 5 Mar 10 thru Mar 12 Mar 17 thru Mar 19 Philadelphia, PA Area FORMCHECKBOX Princeton, NJ Area FORMCHECKBOX Warrendale, PA Area FORMCHECKBOX Name for Examiner Certificate: FORMTEXT ?????Examiner StatementI attest to the accuracy of the information I provided in this application.I have read the duties of an Examiner on the MAAPE web site and understand the commitment I am making to the Mid-Atlantic Alliance for Performance Excellence. I understand that MAAPE will charge a $500 fee if I attend Examiner Training and do not fulfill these duties.If I am chosen to be an Examiner, I will abide by the Code of Ethical Standards and the Terms and Conditions of Appointment.Initials required: FORMTEXT ?????*Recommendation Form is not required for former MAAPE Examiners*Recommendation Form2020 Board of ExaminersMid-Atlantic ALLIANCE for Performance Excellence FORMTEXT ????? has applied to be a member of the 2020 Board of Examiners for the MID-ATLANTIC Alliance for Performance Excellence Award Program and has indicated you would provide a recommendation. The role of Examiners is to evaluate applicants for the Mid-Atlantic Alliance for Performance Excellence Award Program based on the Baldrige Excellence Framework. Examiners review, write an analysis of, and score written applications, then prepare feedback reports to applicants. They also participate in consensus evaluations and site visits. In doing so, Examiners are required to have expertise in business, education or health care management, processes and results; have knowledge of practices and improvement strategies leading to performance excellence; possess and use good analytical, writing and oral communication skills; and work as cooperative team members. Please provide a recommendation relating to your knowledge of the applicant’s qualifications to be an Examiner. Complete this form and submit it electronically to bbitner@ or return the form to the applicant for submission with his/her completed application. Recommendation forms must be received no later than Friday, January 24th , 2020.Please note: photocopies and fax copies are not acceptable.Please indicate your evaluation of the applicant’s ability to assess an organization’s efforts in the seven Categories of the Baldrige Excellence Framework by placing an “X” in the appropriate column.HighlyLeadingUnknownUnsatisfactoryQualifiedQualifiedExpertLeadership FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Strategy FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Customers FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Measurement, Analysis & Knowledge Management FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Workforce FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Operations FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Results FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Please indicate your assessment of the applicant’s knowledge or skill in the following areas by placing an “X” in the appropriate column.HighlyLeadingUnknownUnsatisfactoryQualifiedQualifiedExpertGeneral Management FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Analysis of Results FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Written Communication FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Improvement Strategies FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Leadership FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Interpersonal Relationships FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Education or Training FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Results FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Recommendation Form2020 Board of ExaminersApplication m – 9Page 16Applicant’s Name: FORMTEXT ?????Applicant Phone No.: FORMTEXT ?????Reference Name: FORMTEXT ?????Reference Phone No.: FORMTEXT ?????Reference Title: FORMTEXT ?????Years Known Applicant: FORMTEXT ?????Reference Employer: FORMTEXT ?????Please describe the applicant’s qualifications to be an Examiner. FORMTEXT ?????Reference Signature FORMTEXT ?????Date FORMTEXT ?????Please return electronically to bbitner@ or by mail to: Mid-Atlantic Alliance for Performance ExcellenceBoard of Examiners Selection590 Centerville Road, #260Lancaster, PA 17601Code SectorCode SectorCode Sector111 Crop Production112 Animal Production113 Forestry and Logging114 Fishing,Hunting and Trapping115 Support Activities for Agriculture and Forestry211 Oil and Gas Extraction212 Mining (except Oil and Gas)213 Support Activities for Mining221 Utilities233 Building,Developing and General Contracting234 Heavy Construction235 Special Trade Contractors311 Food Manufacturing312 Beverage and Tobacco Product Manufacturing313 Textile Mills314 Textile Product Mills315 Apparel Manufacturing316 Leather and Allied Product Man.321 Wood Product Manufacturing322 Paper Manufacturing323 Printing and Related Support Activities324 Petroleum and Coal Products Man.325 Chemical Manufacturing326 Plastics and Rubber Products Man.327 Nonmetallic Mineral Product Manufacturing331 Primary Metal Manufacturing332 Fabricated Metal Product Manufacturing333 Machinery Manufacturing3331 Agriculture, Construction, and Mining Machinery Man.3332 Industrial Machinery Manufacturing3333 Commercial and Service Industry Machinery Manufacturing3334 Ventilation, Heating, Air-Conditioning and Commercial Refrigeration Equipment Manufacturing3335 Metalworking Machinery Man.3336 Engine, Turbine, and Power Transmission Equipment3339 Other General Purpose Machinery Manufacturing334 Computer and Electronic Product Manufacturing3341 Computer and Peripheral Equipment Manufacturing3342 Communications Equipment Manufacturing3344 Semiconductor and Other Electronic Component Manufacturing335 Electrical Equipment, Appliance and Component Manufacturing3353 Electrical Equipment Manufacturing-Power Distribution and Specialty Transformer; Motor and Generator; Switchgear; and Relay and Industrial Control Man.3359 Other Electrical Equipment and Component Manufacturing-Battery; Communication and Energy Wire and Cable; and Wiring Device Manufacturing336 Transportation Equipment Manufacturing337 Furniture and Related Product Manufacturing339 Miscellaneous Manufacturing421 Wholesale Trade, Durable Goods422 Wholesale Trade, Nondurable Goods441 Motor Vehicle and Parts Dealers442 Furniture and Home Furnishings Stores443 Electronics and Appliance Stores444 Building Material and Garden Equipment and Supplies Stores445 Food and Beverage Stores446 Health and Personal Care Stores447 Gasoline Stations448 Clothing and Clothing Accessories Stores451 Sporting Goods, Hobby, Book and Music Stores452 General Merchandise Stores453 Miscellaneous Store Retailers454 Nonstore Retailers481 Air Transportation482 Rail Transportation483 Water Transportation484 Truck Transportation485 Transit and Ground Passenger Transportation486 Pipeline Transportation487 Scenic and Sightseeing Transportation488 Support Activities for Transportation491 Postal Service492 Couriers and Messengers493 Warehousing and Storage Facilities511 Publishing Industries512 Motion Picture and Sound Recording Industries513 Broadcasting and Telecommunications514 Information Services and Data Processing Services521 Monetary Authorities-Central Bank522 Credit Intermediation and Related Activities5221 Depository Credit Intermediation5222 Non-Depository Credit Intermediation5223 Activities Related to Credit Intermediation523 Securities, Commodity Contracts and Other Intermediation5231 Securities and Commodity Contracts Intermediation5232 Securities and Commodity Exchanges5239 Other Financial Investment Activities524 Insurance Carriers and Related Activities525 Funds, Trusts and Other Financial Vehicles (U.anizations)5251 Insurance and EmployeeBenefit Funds5259 Other Investment Pools andFunds531 Real Estate532 Rental and Leasing Services533 Owners and Lessors of Other Non-Financial Assets541 Professional, Scientific and Technical Services551 Management of Companies and Enterprises561 Administrative and Support Services 562 Waste Management and Remediation Services611 Educational Services621 Ambulatory Health Care Services622 Hospitals623 Nursing and Residential Care Facilities624 Social Assistance711 Performing Arts, Spectator Sports and Related Industries712 Museums, Historical Sites and Similar Institutions713 Amusement, Gambling and Recreation Institutions721 Accommodations (hotels)722 Food Services and Drinking Places811 Repair and Maintenance812 Personal and Laundry Services813 Religious, Grant Making, Civic, and Professional and Similar Organizations921 Executive, Legislative, Public Finance and General922 Justice, Public Order, Safety923 Administration of Human Resource Programs924 Administration of Environmental Quality Programs925 Administration of Housing Programs, Urban Planning926 Administration of Economic Programs927 Space Research and Technology928 National Security and International Affairs999 Unclassified Establishments American Industry Classification ................
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