DRIVER OF THE YEAR NOMINATION FORM

Transcription

1 DRIVER OF THE YEAR NOMINATION FORM PURPOSE PURPOSE: This program honors those drivers who operate their vehicles in a safe and responsible manner, excel in the Lytx DriveCam safety program, and whose contributions have enhanced the overall image of the transportation industry. This recognition is a great way to celebrate your best and safest drivers. APPLICATION PROCEDURE: Nomination forms must be delivered to Lytx by the close of business January 8, Please submit your form by ing the PDF to awards@lytx.com. ELIGIBILITY REQUIREMENTS:. Your driver must be a full-time employee of your company at the time of nomination, the time of winner selection, and the awards presentation (February 2018). Your driver must have participated in the DriveCam safety program continuously from January 1, 2017 through December 31, All sections must be completed. Nomination forms must have the signatures of the nominated Driver and a corporate representative. JUDGING PROCESS: A Lytx Driver of the Year as well as 2nd and 3rd place winners for each industry will be selected from the eligible submissions. A Lytx panel will review the applications to consider the merits of each candidate based on the submitted information as well as their performance within the DriveCam program. THE AWARD: Results will be finalized by January 12, Winners will be privately notified between January 12 and 19, st place winners from each industry will receive $1500 plus a trip for two to San Diego, CA; 2nd place $500 and 3rd place $250. Winners from organizations that do not permit monetary awards may elect to have the value of the award donated to their favorite charity. The first place winner in each industry will win a trip for two to San Diego to receive their award during our annual User Group Conference. This reward includes complimentary coach airfare and two-night standard hotel accommodations at the Paradise Point Resort & Spa. Winners will be publicly announced and honored in San Diego at the Lytx User Group Conference in February 2018.

2 SECTION 1: DRIVER INFORMATION 1. Which industry does the Driver belong to? Please select one category.* Waste/Construction Transit/Motor Coach For-Hire Trucking Private Truck Fleet Services/Utilities Government Other (please specify) 2. Who are you nominating? (Driver s first and last name)* 3. Company name* 4. Who s submitting the nomination? (Your first and last name)* 5. Your address* 6. Site and Group that Driver is assigned to in DriveCam Online (for Lytx performance verification in the DriveCam Program) 7. License endorsements

3 8. Type of vehicle operated in 2017 by Driver 9. Driver s work-related miles driven in Driver s total years of work-related driving 11. Number of years the Driver has been with current employer SECTION 2: SAFETY ACHIEVEMENTS 1. List all safety awards or other safety recognition the nominee has received (include dates and sources), as well as any other information that demonstrates a commitment to safety. 2. Has the nominee been involved in any preventable vehicle collisions or had any moving violations in the past 3 years? If yes, please describe.

4 SECTION 3: COMMUNITY SERVICE 1. List all community service activities and/or personal recognition awards received (outstanding work, meritorious action, etc.). Include dates and sources for awards. SECTION 4: DRIVER STATEMENT 1. Statement from driver on how he/she maintains his/her own commitment to customer service, company goals, safety and compliance, and overall professionalism and courtesy. Or, send a driver statement with cover note to awards@lytx.com.

5 SECTION 5: COMPANY CERTIFICATION & AGREEMENT In consideration of our employee being allowed to participate in this program, this company does certify and agree to the following: 1. All of the statements contained in the form, or otherwise submitted to Lytx (whether to or by another method), in support for this nomination are true to the best of the company s knowledge. These statements have been investigated by the company to the best of its ability and a company representative has personally reviewed the information submitted with the driver. 2. It is agreed that should our employee receive the title Lytx Driver of the Year the company will work to protect and maintain the high status of his/her recognition. 3. It is understood that if a nominee s status with this company changes (e.g. retirement, leaves the company) between nomination and public announcement of the awards, the nominee becomes ineligible and the company will immediately notify Lytx. 4. Company, as specified below, and nominee gives permission for Lytx to use the winner s name and image, Company s name and logo, as well as any statements or media submitted in connection with this nomination (whether submitted in this application, to awards@lytx.com, or by another method) for promotional purposes. The nominee interview and investigation of the facts submitted in support of this nomination have been made by: 1. Company Management Representative* 2. Title 3. address* 4. Phone number* 5. Company* 6. Signature (by typing your name here, you are certifying that this is your electronic signature)* 7. Date / / MM DD YYYY

6 SECTION 6: DRIVER CERTIFICATION & AGREEMENT In consideration of my nomination for Lytx s Driver of the Year Program and to be eligible for any awards and recognition offered, I hereby certify and agree to the following: 1. All of the statements contained in the form submitted in support of my nomination, as well as any other materials or statements submitted to Lytx (whether to awards@lytx.com or by another method) in connection with this nomination are true. I authorize Lytx and its representatives to make an independent review of all information submitted on behalf of my nomination. 2. I authorize Lytx and its designated agencies to make full use of the above-described information about myself supplied with this application, including any media, statements or other information submitted in connection with this application (whether submitted to awards@lytx.com, via telephone interview, or by another method), along with photographs or video taken under Lytx direction, in promotional and publicity-related activities. I further agree to make myself available for publicity interviews, which may be arranged by Lytx. 3. I will conduct myself in such a way as to protect and maintain the high status of the honor bestowed upon me. I agree that this recognition may not be used in any advertising, promotion or exhibition without written approval from Lytx. 1. Driver s name* 2. Signature (by typing your name here, you are certifying that this is your electronic signature)* 7. Date / / MM DD YYYY THANK YOU! YOUR DRIVER OF THE YEAR AWARD NOMINATION IS COMPLETE. Please submit your form by ing the PDF to awards@lytx.com.