University of California | Office of The President
STAFF APPRECIATION AND RECOGNITION (STAR)UCOP Nomination FormPlease complete this form and send to StarAwardSubmissions@UCOP.eduName of Nominee: FORMTEXT ?????Employee ID: FORMTEXT ?????Employee Unit/Department: FORMTEXT ?????Employee Job Title: FORMTEXT ?????Job Title Code: FORMTEXT ?????Amount of Award: FORMTEXT ?????FAU: FORMTEXT ?????USE SUB 01 ONLYDOS Code: XSLProvide a brief description (2 paragraph limit) of the specific reason for nomination and link to one or more of the award criteria. Describe how the employee or team completed work on a specific project or event that is above and beyond the normal scope of an employee’s regular job scope that warrants a STAR Award.. FORMTEXT ?????Nominator Name: FORMTEXT ?????Signature: FORMTEXT ????? (electronic signature accepted)Date: FORMTEXT ?????Nominator’s Unit/Department: FORMTEXT ?????Nominator’s email address: FORMTEXT ?????Phone: FORMTEXT ?????Eligibility for award (all criteria must be met): FORMCHECKBOX Nominee is a: policy-covered career PSS employee, MSP employee, or exclusively represented employees in the Clerical Unit (CX). FORMCHECKBOX Nominee is on active pay status or on an approved unpaid leave. FORMCHECKBOX Nominee has a performance rating of Successfully Meets Expectations or better overall rating on their most recent annual performance evaluation.? (PPSM 23 requires that written performance evaluations be completed annually.) New employees who have not yet received an annual performance evaluation may be eligible for an award if their manager confirms on the nomination form that they are “successfully meeting expectations” and attaches a written review of performance. FORMCHECKBOX Nominee has worked on a specific project or event that is above and beyond the normal scope of his/her regular job scopeApproval Signatures (see STAR program guidelines for required approvals):*Information RequiredNote: Approval signature includes budget approval for FAU listed above.*Employee Supervisor Name : FORMTEXT ?????*Approval Signature: FORMTEXT ?????(electronic signature accepted)Date: FORMTEXT ?????*Department Head Name:(for all awards) FORMTEXT ????? *Approval Signature: FORMTEXT ?????(electronic signature accepted)Date: FORMTEXT ?????*Division Head Name:(for all awards) FORMTEXT ?????*Approval Signature: FORMTEXT ?????(electronic signature accepted)Date: FORMTEXT ?????Official Use Only: Executive Director, Human Resources:Name: Nancy PluzdrakApproval Signature: FORMTEXT ?????Date: FORMTEXT ?????Executive Director, Operations:Name: Thera KalmijnApproval Signature: FORMTEXT ?????Date: FORMTEXT ????? FORMCHECKBOX Award Approved FORMCHECKBOX Award Denied Reason for Denial: FORMTEXT ????? ................
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