Operator of the Year Nomination Form INSTRUCTIONS: All fields must be completed for Award eligibility. Please refer to the Operator of the Year" Awards Criteria as you complete this application. To be considered in the next Award, your completed form must be submitted by extended deadline July 17, 2018. GOOD LUCK! Operator DescriptionOperator Name*Plant/Employer*State PWS ID#*TCEQ Plant ID#*Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Telephone*Email Address* Brief Treatment Process Overview* PersonalYears of Experience*Years with Present Employer*Operator's License No. and Classification*Previous Plant Operations Experience*Please Provide the Number of Education Contact Hours and List Courses Attended During the Past 24 Months:* ProfessionalSCMA Membership (years)*Years in Present Job*Operator Deserves This Award Because*Upload any supporting documents with this application that may be helpful in evaluation your candidate for the Outstanding Operator Award.Upload File Drop files here or Describe How the Operator Exhibits a Job Effort that is Above and Beyond the Normal Requirement for His or Her Position.*Upload any supporting documents with this application that may be helpful in evaluation your candidate for the Outstanding Operator Award.Upload File Drop files here or Describe How the Operator Demonstrates a Working Knowledge of Membrane Process and Willingness to Further their Knowledge on a Regular Basis.*Upload any supporting documents with this application that may be helpful in evaluation your candidate for the Outstanding Operator Award.Upload File Drop files here or Describe How the Operator Represents His or Her Employer in Positive Manner in the Water or Wastewater Industry.*Upload any supporting documents with this application that may be helpful in evaluation your candidate for the Outstanding Operator Award.Upload File Drop files here or List Any Awards or Honors the Operator has Received.*Upload any supporting documents with this application that may be helpful in evaluation your candidate for the Outstanding Operator Award.Upload File Drop files here or Your Contact InformationYour Name*Title*TelephoneEmail Address* Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Communication and Data Sharing PreferenceSCMA has been diligent in Data Security and being compliant with US and other Nations regulations.Email Notifications*Authorization for receiving publication email notification from SCMA.(applies to all email addresses on this form)Yes, I authorize receiving publication email notificationsNo, I would not like to receive publication email notifications (opt-out)Data Sharing*Opt-In: It is ok to share my contact information (name, job title, company, address, email, phone, etc.) with SCMA Board, Event Sponsors, Speakers, Moderators & Attendees.Opt-Out: Do not share my contact information. Outside of SCMA Administration, only my name, title and company will be shared with SCMA Board, Event Sponsors, Speakers, Moderators & Attendees. CaptchaEnter the letters displayed to prove you're human.