Disability Employment Awareness Award

2019 Employer Nomination Form

The Disability Employment Awareness Award is presented to an Arlington Heights Employer who pro-actively recruits, hires, and employs persons with disabilities. Self nominations are encouraged. All nominations must be submitted no later than Friday August 30, 2019.

Company Nomination

Company Name

Company Phone

Company Email

Contact's Phone

Additional Phone Number

Please describe the reason/s your nominee deserves the Disability Employment Awareness Award...

Submitted By

Phone Number

Additional Phone Number

Relationship to Employer

The Disability Employment Awareness Award is sponsored by the Arlington Heights Commission for Citizens with Disabilities. Forward submissions to:

Village of Arlington Heights
c/o David Robb, Disability Services Coordinator
33 S. Arlington Heights Road
Arlington Heights, IL 60005

P: 847.368.5793
F: 847.368.5980
E: drobb@vah.com

Disability Employment Awareness Award

2019 Employer Nomination Form

Company Nomination

Company Address

Company Contact

Submitted By

Full Name

Full Address