<p> NOMINATION FORM VICTORIAN MANUFACTURING HALL OF FAME HONOUR ROLL</p><p>This award recognises an individual who has made a sustained contribution to Victoria’s manufacturing industry. The judging criteria is weighted across promotion of advanced manufacturing initiatives, sustainability, export, sustained contribution to the manufacturing sector, quality management initiatives, size and capability of the companies managed, academic record and contribution to the community.</p><p>Nominations must be filled out in full and submitted to the Victorian Manufacturing Hall of Fame Secretariat by Monday, 23 February 2015. Only typed entries will be accepted.</p><p>NOMINEE</p><p>Individual</p><p>Title</p><p>Organisation</p><p>Business Address</p><p>Telephone number</p><p>Email address</p><p>Age (or Date of birth)</p><p>Executive Assistant (if any)</p><p>Executive Assistant Telephone number</p><p>Executive Assistant email address</p><p>In recognition of the individual achieving</p><p>Page 1 Contribution to the Victorian manufacturing sector</p><p>Manufacturing initiatives</p><p>Mentoring/skills development of employees</p><p>Nominee’s bio (up to 500 words) nominee)</p><p>Board positions</p><p>Images Submit with your application 2x high resolution photographs of the nominee </p><p>Page 2 DECLARATION BY NOMINATOR</p><p>The nominating entity, as a condition of recommending the above person, confirms it has satisfied itself that the nominee is of good repute and has not been convicted of breach of WorkCover, Trade Practices Act, Environmental Protection Act, Equal Opportunity Act or other State or Federal laws within the previous 12 months or if convicted have not had imposed on any of them a penalty of more than $10,000 for any such breach.</p><p>I hereby declare that the information provided in this nomination is correct at the time of submission and that the individual I have nominated is employed within the State of Victoria, Australia.</p><p>Signature Name in full Title Organisation Mobile Telephone Number Email address Date</p><p>Please attach evidence of the awards (eg: copies of Award Certificates), the completed nomination form, images and email or mail full submission to Alison O’Keefe, Industry Programs Branch, Department of Economic Development, Jobs, Transport and Resources, GPO Box 4509RR, Melbourne Victoria 3001 or by email to Victorian Manufacturing Hall of Fame Secretariat [email protected] by the close of business, Monday, February 23, 2015. </p><p>The Victorian Manufacturing Hall of Fame has been established to publicly acknowledge excellence in Victorian manufacturing and to promote this excellence to a global industrial market and the general public.</p><p>CONDITIONS</p><p>1. Individuals nominated for Victorian Manufacturing Hall of Fame Honour Roll must have demonstrated experience, achievement and commitment within Victoria in a manufacturing plant or a specialist design service provider to the Victorian manufacturing industry or as a service provider to the Victorian manufacturing industry including contributions to industry associations. 2. Nominations for individuals for the Victorian Manufacturing Hall of Fame Honour Roll will only be accepted from: a. Incorporated Australian industry associations b. Companies that wish to nominate employees. c. Other industry entities approved by the Minister 3. Outstanding achievement can relate to any facet of manufacturing for example marketing, work safety, design, technology, supply chain management, professional services etc. 4. Any individual recognised by the Victorian Manufacturing Hall of Fame Honour Roll, who is, after induction, convicted of any criminal offence or legislative breach may be asked to show cause as to why they should not have their recognition revoked and be required to remove any reference to the Hall of Fame recognition by the Victorian Government. The Minister will then decide in her absolute discretion whether the individual will have the award revoked. 5. The nominations will be judged by an industry panel. 6. The Minister’s decision on the eligibility of individuals being nominated, the entities nominating them or the provision or revocation of recognition is final and no correspondence will be entered into. 7. The individual nominated agrees to have their name associated with the Victorian Manufacturing Hall of Fame and promoted within the media and on the Victorian Manufacturing Hall of Fame website. 8. The nominations for the Honour Roll will be judged by an industry panel. 9. The Honour Roll recipients for the 2015 Victorian Manufacturing Hall of Fame will be announced at the 2015 Victorian Manufacturing Hall of Fame Gala Dinner to be held on Tuesday, May 26, 2015 at the Palladium Ballroom, Crown Entertainment Centre.</p><p>Page 3</p>