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Nomination Form <br />Orange SLICE Superstar <br />Employee being nominated: <br />Department of nominee: <br />Employee making nomination: <br />Phone #: <br />I nominate the above employee as an Orange Slice Superstar because of their ability to <br />Successfully Live and be Inspiring to County Employees in the following way(s): <br />Made significant changes to improve his /her health over the past year <br />Serve as a role model to the nominator and other employees <br />Other (briefly describe) <br />Explain what the individual has done to inspire you, providing as much detail as possible. <br />Continue on a second page if necessary. The more information you can provide, the more <br />likely your nominee will be selected.) <br />Please keep my name confidential throughout the nomination process. Yes No <br />Nominator Signature: <br />Date: <br />Examples of nominations are on the back of this page. <br />16 <br />