Florida Sheriffs Association Lifetime Achievement Award Nomination Form

Lifetime Achievement Award Nomination Form

Sheriffs may nominate sheriffs' office employees with 40 years of service or more in law enforcement for the FSA Lifetime Achievement Award. To be eligible for the award, a sheriffs’ office employee must have a total of 40 years of sworn or non-sworn service in law enforcement, with at least 20 years and one day of service being with a Florida sheriff's office (excluding military service). Award recipients will receive a plaque acknowledging their dedication, as well as a lifetime honorary membership in FSA. Submission of employees for consideration must be approved by their current sheriff.
Agency Information

This nomination was approved for submission by:
County*
Sheriff*
Nominee Information

This information will be used to design the award, and enroll the recipient as a FSA Lifetime Honorary Member.
Nominee Name*

Title/RankFirst NameLast NameSuffix
Nominee is:
Home Address (where we will mail the membership cards, magazines, etc)*

Street Address

Street Address 2

CityState / Province

Postal / Zip Code
Home Phone Number*

Area CodePhone Number
Home Email Address*
example@example.com
Nominator's Contact Information

This individual will receive the nomination confirmation and future correspondence related to this award.
Name*

Title/RankFirst NameLast NameSuffix
Agency Name and Address*

Agency Name

Street Address

CityState / Province

Postal / Zip Code
Nominator Phone Number*

Area CodePhone Number
Nominator Email Address*
example@example.com
Ship Lifetime Achievement Award plaque to:

Same as above
If shipping will go to an individual other than the Nominator, please include this information here: *

First NameLast Name
Shipping Address*

Agency Name

Street Address

CityState / Province

Postal / Zip Code
Plaque Shipments: The Florida Sheriffs Association will ship the Lifetime Achievement Award plaques to sheriffs’ offices once a month. From the date of the nomination, please allow up to four weeks for delivery.

FSA Lifetime Honorary Membership Enrollment: Award recipients will automatically be enrolled as an FSA Lifetime Honorary Member, and their materials will be shipped directly to them. If the nomination form indicates the individual is unaware of the pending award, FSA will ship the membership materials after the plaque presentation date.
Plaque Presentation Date*

MonthDayYear
Will the nominee be made aware of this award prior to presentation?*

YesNo
Qualifying Criteria

To be eligible for the award, a sheriffs’ office employee must have a total of 40 years of sworn or non-sworn service in law enforcement with at least 20 years plus one day of service for a Florida sheriff (excluding military service).
Agency Name 1*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Years of Service (Auto Calculated)
Add another agency
Agency Name 2*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Years of Service
Add another agency
Agency Name 3*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Years of Service
Add another agency
Agency Name 4*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Years of Service
Add another agency
Agency Name 5*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Years of Service
Add another agency
Agency Name 6*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Years of Service
Add another agency
Agency Name 7*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Years of Service
Add another agency
Agency Name 8*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Years of Service
Add another agency
Agency Name 9*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Years of Service
Add another agency
Agency Name 10*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Years of Service
BlankAgencyName
Should be Empty:

Lifetime Achievement Award Nomination Form

Agency Information

Nominee Information

Nominator's Contact Information

Qualifying Criteria