BPOY Nomination Form 2020 Error NOMINEE AND BUSINESS INFORMATION Nominee Name Eligible business leaders include those who may be, but are not required to be, business owners, and who have been with their company for at least three full fiscal years. Only single applicants (rather than teams or co-owners) will be considered for this honor. Nominee Title Years in Current Leadership Position Nominee Email Nominee Phone Use this format: ###-###-#### Company Name Street Address City, State, Zip General Phone Use this format: ###-###-#### Website Year Founded Number of employees in the U.S. (FTEs) Full time equivalents (FTEs) excluding contractors Nominated By BRIEF Description of Business (max 100 words) Please list your target customer(s) AUTHORIZATION REQUEST In the event that the Nominee becomes a finalist for the Award, the SBC/Rochester Chamber Selection Committee will contact the Nominee’s accountant, and may contact the Nominee’s attorney, to verify the data and information submitted in the Application. ATTORNEY INFORMATION Attorney Name In the event that the Nominee becomes a finalist for the Award, the SBC/Rochester Chamber Selection Committee may contact the Nominee’s attorney to verify the data and information submitted in the Nomination Form. Law Firm Name Attorney Email Attorney Phone Use this format: ###-###-#### ACCOUNTANT INFORMATION Accountant Name In the event that the Nominee becomes a finalist for the Award, the SBC/Rochester Chamber Selection Committee will contact the Nominee’s accountant to verify the data and information submitted in the Nomination Form. Accounting Firm Name Accountant Email Accountant Phone Use this format: ###-###-#### NOMINEE AUTHORIZATION By electronically signing below, the Nominee authorizes the members of the Selection Committee to contact the accountant and attorney listed above for the sole purpose of verifying the information submitted in the application. Nominee Signature Date Signed mm/dd/yyyy SUPPORTING INFORMATION Leadership: How do you define leadership, and how do you perceive your role as a leader? (500 word max) Define leadership and your role as a leader. Max 500 words Leadership: How are you positioning your company to excel in its market amidst the Novel Coronavirus (COVID-19) pandemic, how do you think your Company has fared during the pandemic, and what are your expectations for the future? (500 word max) COVID-19 pandemic response; future expectations. Max 500 words Leadership: What would you like your legacy to be with your company? (500 word max) Your legacy Max 500 words Leadership: Describe what values you promote within your organization, and example(s) of how these values were used in decision(s) you have made over the past year? (500 word max) Values Max 500 words Achievements: Please list up to 5 of your company's proudest achievements and describe your contribution to these achievements. (For example, business and industry awards, customer and employee satisfaction, etc.) (500 word max) Proudest achievements Max 500 words Company Performance: What measures do you feel are important to show the performance of your company over the last 3 years, what are they, why are they important, and what was your contribution to them? (500 word max) Company performance measures COMPANY PERFORMANCE DETAILS Please indicate below, for each of the last 3 years, the rate of revenue change year over year, employee headcount in the U.S. (FTEs), and any other specific metrics that you want to share, for example market share, customer satisfaction, employee retention, customer growth, etc. 2018 DETAILS 2018 Rate of Revenue Change Year over Year (%) 2018 Number of employees in the U.S. (FTEs) Full time equivalents (FTEs) excluding contractors 2018 Other Metrics Any other specific metrics that you want to share, for example market share, customer satisfaction, employee retention, customer growth, etc. 2019 DETAILS 2019 Rate of Revenue Change Year over Year (%) 2019 Number of employees in the U.S. (FTEs) Full time equivalents (FTEs) excluding contractors 2019 Other Metrics Any other specific metrics that you want to share, for example market share, customer satisfaction, employee retention, customer growth, etc. 2020 DETAILS 2020 Rate of Revenue Change Year over Year (%) Full year financials may not be available. Please submit if possible. Interim financials and 3Q are acceptable. Please label accordingly. 2020 Number of employees in the U.S. (FTEs) Full time equivalents (FTEs) excluding contractors 2020 Other Metrics Any other specific metrics that you want to share, for example market share, customer satisfaction, employee retention, customer growth, etc. ADDITIONAL INFORMATION What have you not shared above that you feel is important for us to know? Please describe your involvement. For example, charitable causes, volunteering, support of education, mentoring, company's community efforts, military service, influential life experiences, etc. Additional Information you would like to share REFERENCE LETTERS Feel free to include up to three letters of reference. Appropriate reference sources could include (but aren’t limited to) professional advisors, employees, vendors, customers, and/or peers. Allowed file types: PDF, DOC, TXT) Reference Letter 1 2MB Limit Reference Letter 2 2MB Limit Reference Letter 3 2MB Limit