2018 Mid-Atlantic Alliance for Performance Excellence Board of Examiners

2018 Mid-Atlantic Alliance for Performance Excellence Board of Examiners This form is fill-in enabled. Please complete all sections and submit it to [email protected]. 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 12, 2018 (Recommendation Form may be sent separately but must be RECEIVED by January 30, 2018)

TEL: 717-737-6470 midatlanticape.org

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

Last Name:

Employer:

Title:

Preferred Mailing Address: Home Work 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):

Mid-Atlantic Alliance for Performance Excellence 2018 New Examiner Application

717-737-6470• Midatlanticape.org page 1 Experience 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:

717-737-6470• Midatlanticape.org page 2 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:

None Very Little Proficient Expert 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:

None Very Little Proficient Expert 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

Education and Training Background 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 Mid-Atlantic Alliance for Performance Excellence 2018 New Examiner Application

717-737-6470• Midatlanticape.org page 3 Provide a brief description of your experience on teams and why you are an effective team member.

717-737-6470• Midatlanticape.org page 4 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). List the title and audience of major speeches during the past two years.

Outreach Activities, Achievements, Recognition and/or Professional Affiliations

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

Examiner Preparation

Webinars A 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 18 - 9am to 11am Jan 25 - 3pm to 5pm Feb 1 - 9am to 11am Feb 8 - 3pm to 5pm Please block your calendars so that you can participate in ALL FOUR webinars.

In-class training All examiners must complete the prework and participate in the three-day training course. Please indicate your first and second choice of 2018 training dates by marking “1” and “2” in the fields below.

Feb 27-Mar 1 Mar 6-8 Mar 13-15 Philadelphia Area New Jersey Pittsburgh Area

Name for Examiner Certificate:

Examiner Statement I 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:

717-737-6470• Midatlanticape.org page 5 *Recommendation Form is not required for former MAAPE Examiners*

RECOMMENDATION FORM 2018 BOARD OF EXAMINERS

MID-ATLANTIC ALLIANCE FOR PERFORMANCE EXCELLENCE

has applied to be a member of the 2018 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 [email protected] or return the form to the applicant for submission with his/her completed application. Recommendation forms must be received no later than Tuesday, January 30, 2018.

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. Highly Leading Unknown Unsatisfactory Qualified Qualified Expert 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

717-737-6470• Midatlanticape.org page 6 RECOMMENDATION FORM 2018 BOARD OF EXAMINERS Application m – 9 Page 16

Applicant’s Name: Applicant Phone No.: Reference Name: Reference Phone No.: Reference Title: Years Known Applicant: Reference Employer:

Please describe the applicant’s qualifications to be an Examiner.

Reference Signature Date

Please return electronically to [email protected] or by mail to:

Mid-Atlantic Alliance for Performance Excellence Board of Examiners Selection 590 Centerville Road, #260 Lancaster, PA 17601

717-737-6470• Midatlanticape.org page 7 North American Industry Classification System (NAICS) Codes Please insert NAICS codes most relevant to your organization’s products and/or services on the first page of the Eligibility Determination Form. If you wish to access the NAICS codes on-line, connect to “http://www.census.gov,” select “subjects A to Z,” select “N,” select “NAICS (North American Industry Classification System).”

Code Sector Code Sector Code Sector

111 Crop Production 3353 Electrical Equipment Manufacturing- 5231 Securities and Commodity Contracts 112 Animal Production Power Distribution and Specialty Intermediation 113 Forestry and Logging Transformer; Motor and Generator; 5232 Securities and Commodity Exchanges 114 Fishing,Hunting and Trapping Switchgear; and Relay and Industrial 5239 Other Financial Investment Activities 115 Support Activities for Agriculture and Control Man. 524 Insurance Carriers and Related Activities Forestry 3359 Other Electrical Equipment and 525 Funds, Trusts and Other Financial Vehicles 211 Oil and Gas Extraction Component Manufacturing-Battery; (U.S.Organizations) 212 Mining (except Oil and Gas) Communication and Energy Wire and 5251 Insurance and Employee 213 Support Activities for Mining Cable; and Wiring Device Benefit Funds 221 Utilities Manufacturing 5259 Other Investment Pools and 233 Building,Developing and General 336 Transportation Equipment Manufacturing Funds Contracting 337 Furniture and Related Product Manufacturing 531 Real Estate 234 Heavy Construction 339 Miscellaneous Manufacturing 532 Rental and Leasing Services 235 Special Trade Contractors 421 Wholesale Trade, Durable Goods 533 Owners and Lessors of Other Non-Financial 311 Food Manufacturing 422 Wholesale Trade, Nondurable Goods Assets 312 Beverage and Tobacco Product 441 Motor Vehicle and Parts Dealers 541 Professional, Scientific and Technical Manufacturing 442 Furniture and Home Furnishings Stores Services 313 Textile Mills 443 Electronics and Appliance Stores 551 Management of Companies and Enterprises 314 Textile Product Mills 444 Building Material and Garden Equipment 561 Administrative and Support Services 562 315 Apparel Manufacturing and Supplies Stores Waste Management and Remediation 316 Leather and Allied Product Man. 445 Food and Beverage Stores Services 321 Wood Product Manufacturing 446 Health and Personal Care Stores 611 Educational Services 322 Paper Manufacturing 447 Gasoline Stations 621 Ambulatory Health Care Services 323 Printing and Related Support Activities 448 Clothing and Clothing Accessories Stores 622 Hospitals 324 Petroleum and Coal Products Man. 451 Sporting Goods, Hobby, Book and Music 623 Nursing and Residential Care Facilities 325 Chemical Manufacturing Stores 624 Social Assistance 326 Plastics and Rubber Products Man. 452 General Merchandise Stores 711 Performing Arts, Spectator Sports and 327 Nonmetallic Mineral Product Manufacturing 453 Miscellaneous Store Retailers Related Industries 331 Primary Metal Manufacturing 454 Nonstore Retailers 712 Museums, Historical Sites and Similar 332 Fabricated Metal Product Manufacturing 481 Air Transportation Institutions 333 Machinery Manufacturing 482 Rail Transportation 713 Amusement, Gambling and Recreation 3331 Agriculture, Construction, and Mining 483 Water Transportation Institutions Machinery Man. 484 Truck Transportation 721 Accommodations (hotels) 3332 Industrial Machinery Manufacturing 485 Transit and Ground Passenger Transportation 722 Food Services and Drinking Places 3333 Commercial and Service Industry 486 Pipeline Transportation 811 Repair and Maintenance Machinery Manufacturing 487 Scenic and Sightseeing Transportation 812 Personal and Laundry Services 3334 Ventilation, Heating, Air-Conditioning 488 Support Activities for Transportation 813 Religious, Grant Making, Civic, and and Commercial Refrigeration 491 Postal Service Professional and Similar Organizations Equipment Manufacturing 492 Couriers and Messengers 921 Executive, Legislative, Public Finance and 3335 Metalworking Machinery Man. 493 Warehousing and Storage Facilities General 3336 Engine, Turbine, and Power 511 Publishing Industries 922 Justice, Public Order, Safety Transmission Equipment 512 Motion Picture and Sound Recording 923 Administration of Human Resource 3339 Other General Purpose Machinery Industries Programs Manufacturing 513 Broadcasting and Telecommunications 924 Administration of Environmental Quality 334 Computer and Electronic Product 514 Information Services and Data Processing Programs Manufacturing Services 925 Administration of Housing Programs, Urban 3341 Computer and Peripheral Equipment 521 Monetary Authorities-Central Bank Planning Manufacturing 522 Credit Intermediation and Related Activities 926 Administration of Economic Programs 3342 Communications Equipment 5221 Depository Credit Intermediation 927 Space Research and Technology Manufacturing 5222 Non-Depository Credit Intermediation 928 National Security and International Affairs 3344 Semiconductor and Other Electronic 5223 Activities Related to Credit Intermediation 999 Unclassified Establishments American Component Manufacturing 523 Securities, Commodity Contracts and Other Industry Classification 335 Electrical Equipment, Appliance and Intermediation Component Manufacturing