2017 Award Cycle 2017 Mid-Atlantic Alliance for Performance Excellence Board of Examiners

This form is fill-in enabled. Please complete all sections of the application and submit it to bbitner@midatlanticpe.org A recommendation is required for new Examiners; the recommendation form is attached. Recommendations may be submitted electronically or mailed to the Mid-Atlantic Alliance for Performance Excellence office.

Title (Mr., Ms., Mrs., Dr.): First Name:       M.I.:      

Street:      

City, State, Zip:      

FedEx Delivery Address (no P.O. Box):      

Primary Phone Secondary Phone Fax

E-mail Address:      
NAICS code(s) (see enclosure) most relevant to expertise: 1.       2.       3.      
If you have been a Mid-Atlantic Alliance for Performance Excellence Examiner previously, list the year(s):
     
Are you an examiner for any other type of award program?       Yes       No

If yes, please specify which award(s):      

For 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:       Number of Employees:      

Complete address of Employer:      

Dates of service:       to present      full-time      part-time

Job Title:       Number of employees supervised:      

Supervisor’s Name:       Title:     

NAICS Codes of Employer:      

Type of products or services:      

Parent company (if applicable):      

Experience in performance improvement associated with this job:     
Employer:       Number of Employees:      

Complete address of Employer:      

Dates of service from:       to:             full-time       part-time

Job Title:       Number of employees supervised:      

Supervisor’s Name:       Title:      

NAICS Codes of Employer:      

Type of products or services:      

Parent company (if applicable):      

Experience in performance improvement associated with this job:     
Employer:       Number of Employees:      

Complete address of Employer:      

Dates of service from:       to:             full-time       part-time

Job Title:       Number of employees supervised:      

Supervisor’s Name:       Title:      

NAICS Codes of Employer:      

Type of products or services:      

Parent company (if applicable):      

Experience in performance improvement associated with this job:     

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:

Leadership

Strategy

Customers

Measurement, Analysis &

Knowledge Management

Workforce

Operations

Results

Please indicate your ability to evaluate applications in the following sectors by placing an X in the appropriate column:

Manufacturing

Service

Small Business

Health Care

Education (P-12)

Post-Secondary Education

Public Sector

Please indicate your level of skills in the following areas by placing an X in the appropriate column:
None Very Little Proficient Expert

Management

Analysis of results

Written communication

Improvement strategies

Leadership

Interpersonal relations

Education or training

Please 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.

     

Written and Oral Communication

Describe your accomplishments in both written and oral communication by citing examples of your most recent and/or relevant experience.

     

Team Experience

Provide a brief description of your experience on teams and why you are an effective team member.

     

Publications/Major Reports/Major Speeches Relevant to Performance Improvement

List the title and citation of your most recent publications or reports first (limit to five examples).

     

     

Describe in 100-300 words why you would like to become a member of the Mid-Atlantic Alliance for Performance Excellence Board of Examiners.

     

All Board of Examiner members must complete prework and participate in one three-day training course. Please indicate your first and second choice of training dates by marking “1” and “2” in the fields below.

A series of four webinars has been scheduled to help examiners to complete the required prework. The webinars will be held from 9 to 11am on the following dates:

Name for Examiner Certificate:      

I attest to the accuracy of the information I provided in this application.

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@midatlanticpe.org, or return the form to the applicant for submission with his/her completed application. Recommendation forms must be received no later than Tuesday, January 31, 2017.

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.

Leadership

Strategy

Customers

Measurement, Analysis &
Knowledge Management

Workforce

Operations

Results

Please indicate your assessment of the applicant’s knowledge or skill in the following areas by placing an “X” in the appropriate column.

Highly Leading
Unknown Unsatisfactory Qualified Qualified Expert

General Management

Analysis of Results

Written Communication

Improvement Strategies

Leadership

Interpersonal Relationships

Education or Training

Results

Recommendation Form

Reference Signature       Date      

590 Centerville Road, #260