2012 TNCPE Board of Examiners - New Examiner Application
Instructions for completing the application:
--This application will take approximately 10 minutes to complete and will require information on past employment, education and experience.  It will also ask for a written response to: "Why you would like to become a member of the Board of Examiners."

--Many fields in the application require a response.  For areas that do not apply to you, please type n/a, which will enable you to finish the application.

--Please make sure you press "Submit" at the end of the form.  The "Submit" button is found immediately after the NAICS codes.  If successfully submitted, you will receive an immediate Google confirmation message as well as confirmation from the TNCPE office by e-mail (within 2-3 days).  

PLEASE NOTE:
One recommendation is required for new examiners.  The Recommendation Form is available on the examiner page of the TNCPE website (www.tncpe.org).  Recommendations may be submitted electronically or mailed to the Tennessee Center for Performance Excellence office.  

THE DEADLINE TO APPLY HAS BEEN EXTENDED.  Your application must be received no later than Friday, April 20, 2012.    
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Title
Clear selection
First Name *
M.I. *
Last Name *
Current Employer *
Job Title *
Street Address *
Please provide your preferred  mailing address.
City *
State *
Zip Code *
Is the above address a home or work address? *
Overnight Delivery Address
If the above address is a P.O. Box, or you would prefer receiving overnight deliveries (FedEx, UPS, DHL) at an alternate address, please include it in the following fields.
Street Address - Overnight Delivery
(123 Main St.)
City - Overnight Delivery
State - Overnight Delivery
Zip Code - Overnight Delivery
Home phone number *
Work phone number *
Cell phone number *
Which is your preferred phone number? *
What is your fax number?
What is your e-mail address? *
NAICS Codes
Please enter  the three NAICS Codes that are most relevant to your expertise.  A list of NAICS codes is found at the end of this form or on the examiner page of the TNCPE website.

NAICS Code 1 *
NAICS Code 2 *
NAICS Code 3 *
If you have been a Tennessee Center for Performance Excellence Examiner previously, list the year(s): *
Have you been an examiner for any other type of award program? *
If yes, please specify which award(s), and include years served:
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: *
i.e. June 2004- present
Job Title: *
Number of employees you supervise: *
Type of Employment *
Supervisor's Name *
Supervisor's Title *
NAICS Codes of Employer *
Types of products or services: *
Parent company:
(if applicable)
Experience in performance improvement associated with this job: *
Employer 2 *
Number of Employees *
Complete address of Employer 2: *
Dates of service from: *
i.e. June 2004 - June 2008
Job Title: *
Number of employees you supervised: *
Type of employment: *
Supervisor's Name from Employer 2: *
Supervisor's Title from Employer 2: *
NAICS Codes of Employer 2: *
Types of products or services: *
Parent company:
(if applicable)
Experience in performance improvement associated with this job: *
Employer 3: *
Number of Employees: *
Complete address of Employer 3: *
Dates of service from: *
i.e. June 2001- June 2003
Job Title: *
Number of employees you supervised: *
Type of employment *
Supervisor's Name from Employer 3: *
Supervisor's Title from Employer 3: *
NAICS Codes of Employer 3: *
Type of products and services: *
Parent company
(if applicable)
Experience in performance improvement associated with this job: *
(if applicable)
Please indicate your level of ability to evaluate applications in the seven Categories of the Criteria for Performance Excellence by marking the appropriate column: *
None
Very Little
Capable
Proficient
Expert
Leadership
Strategic Planning
Customer Focus
Measurement, Analysis and Knowledge Management
Workforce Focus
Operations Focus
Results
Please indicate your level of ability to evaluate applications in the following sectors by marking the appropriate column: *
None
Very Little
Capable
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 marking the appropriate column: *
None
Very Little
Capable
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.  Include publications and speeches if appropriate.
Team Experience *
Provide a brief description of your experience on teams and why you are an effective team member.
Please list outreach activities, achievements, recognition and/or professional affiliations. *
Please describe in 100-300 words why you would like to become a member of the Tennessee Center for Performance Excellence Board of Examiners. *
Examiner Preparation Courses
New examiners are REQUIRED to participate in a one-day Orientation to familiarize you with the principles of the Tennessee Center for Performance Excellence Criteria.  In addition, all Board of Examiner members MUST participate in one three-day training course.  There will be multiple course dates, held in various locations throughout Tennessee.          


New Examiner Orientation Workshop *
Please select which session you would like to attend.
Three-day Training Course / FIRST Choice *
Please note, while we try to accomodate each examiner, you may not get your first choice training date.
Please indicate your SECOND choice examiner training dates *
Please do not pick the same date as your first choice.
Name for Examiner Training Badge: *
Name for Examiner Certificate: *
I attest to the accuracy of the information in this application.  I have read the Examiner general information and requirements and understand the commitment I am making to the Tennessee Center for Performance Excellence.  If I am chosen to be an Examiner, I will abide by the Code of Ethical Standards and the Terms and Conditions of Appointment.     *
Please type your initials below.
NAICS Codes
North American Industry Classification System (NAICS) Codes

Please insert the NAICS codes most relevant to your organization’s products and/or services in the appropriate section of this application.  PLEASE CLICK ON THE SUBMIT BUTTON FOLLOWING THESE CODES TO ENSURE TNCPE RECEIVES YOUR APPLICATION.  THANK YOU!

 
111 Crop Production
112 Animal Production
113 Forestry and Logging
114 Fishing, Hunting and Trapping
115 Support Activities for Agriculture and Forestry
211 Oil and Gas Extraction
212 Mining (except Oil and Gas)
213 Support Activities for Mining
221 Utilities
236 Construction of Buildings
237 Heavy and Civil Engineering Construction
238 Specialty Trade Contractors
311 Food Manufacturing
312 Beverage and Tobacco Product Manufacturing
313 Textile Mills
314 Textile Product Mills
315 Apparel Manufacturing
316 Leather and Allied Product Manufacturing
321 Wood Product Manufacturing
322 Paper Manufacturing
323 Printing and Related Support Activities
324 Petroleum and Coal Products Manufacturing
325 Chemical Manufacturing
326 Plastics and Rubber Products Manufacturing
327 Nonmetallic Mineral Product Manufacturing
331 Primary Metal Manufacturing
332 Fabricated Metal Product Manufacturing
333 Machinery Manufacturing
334 Computer and Electronic Product Manufacturing
335 Electrical Equipment, Appliance, and Component
        Manufacturing
336 Transportation Equipment Manufacturing
337 Furniture and Related Product Manufacturing
339 Miscellaneous Manufacturing
423 Merchant Wholesalers, Durable Goods
424 Merchant Wholesalers, Nondurable Goods
425 Wholesale Electronic Markets and Agents and Brokers
441 Motor Vehicle and Parts Dealers
442 Furniture and Home Furnishings Stores
443 Electronics and Appliance Stores
444 Building Material and Garden Equipment and Supplies
        Dealers
445 Food and Beverage Stores
446 Health and Personal Care Stores
447 Gasoline Stations
448 Clothing and Clothing Accessories Stores
451 Sporting Goods, Hobby, Book, and Music Stores
452 General Merchandise Stores
453 Miscellaneous Store Retailers
454 Nonstore Retailers
481 Air Transportation
482 Rail Transportation
483 Water Transportation
484 Truck Transportation
485 Transit and Ground Passenger Transportation
486 Pipeline Transportation
487 Scenic and Sightseeing Transportation
488 Support Activities for Transportation
491 Postal Service
492 Couriers and Messengers
493 Warehousing and Storage
511 Publishing Industries (except Internet)
512 Motion Picture and Sound Recording Industries
515 Broadcasting (except Internet)
517 Telecommunications
519 Other Information Services
521 Monetary Authorities-Central Bank
522 Credit Intermediation and Related Activities
523 Securities, Commodity Contracts, and Other Financial
        Investments and Related Activities
524 Insurance Carriers and Related Activities
525 Funds, Trusts, and Other Financial Vehicles
531 Real Estate
532 Rental and Leasing Services
533 Lessors of Nonfinancial Intangible Assets (except    
        Copyrighted Works)
541 Professional, Scientific, and Technical Services
551 Management of Companies and Enterprises
561 Administrative and Support Services
562 Waste Management and Remediation Services
611 Educational Services
6111 Elementary and Secondary Schools
6112 Junior Colleges
6113 Colleges, Universities, and Professional Schools
6114 Business Schools and Computer and Management Training
6115 Technical and Trade Schools
6116 Other Schools and Instruction
6117 Educational Support Services
621 Ambulatory Health Care Services
6211 Offices of Physicians
6212 Offices of Dentists
6213 Offices of Other Health Practitioners
6214 Outpatient Care Centers
6215 Medical and Diagnostic Laboratories
6216 Home Health Care Services
6219 Other Ambulatory Health Care Services
622 Hospitals
623 Nursing and Residential Care Facilities
624 Social Assistance
711 Performing Arts, Spectator Sports, and Related Industries
712 Museums, Historical Sites, and Similar Institutions
713 Amusement, Gambling, and Recreation Industries
721 Accommodation
722 Food Services and Drinking Places
811 Repair and Maintenance
812 Personal and Laundry Services
813 Religious, Grantmaking, Civic, Professional, and Similar
        Organizations
814 Private Households
921 Executive, Legislative, and Other General Government
        Support
922 Justice, Public Order, and Safety Activities
923 Administration of Human Resource Programs
924 Administration of Environmental Quality Programs
925 Administration of Housing Programs, Urban Planning, and  
        Community Development
926 Administration of Economic Programs
927 Space Research and Technology
928 National Security and International Affairs

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