2009 Dui Top Gun Award Nomination Form

2017 DUI TOP GUN AWARD NOMINATION FORM

Complete Sections 2 – 5 below by completing the form electronically . Make sure you attach the Reason for Nomination on a separate page. Only complete nominations will be accepted.

1.Reason for Nomination:

Why do you believe this individual has made an outstanding contribution or gone above and beyond in the area of DUI enforcement? (This portion of the application should be typed on a separate sheet(s) of paper, may not exceed two pages, and must be submitted with this completed nomination form.)

2. Nominee Information:

Name and Rank of Nominee: Click or tap here to enter text.

Police Department: Click or tap here to enter text.

Street Address: Click or tap here to enter text.

City/State/Zip: Click or tap here to enter text.

Phone Number: Click or tap here to enter text. Fax Number: Click or tap here to enter text.

Nominee’s Email Address: Click or tap here to enter text.

Nominee’s Number of Years on Job?Click or tap here to enter text.

Is Nominee SFST, ARIDE or DRE Trained? Click or tap here to enter text.

Total Hours Worked by Nominee: Click or tap here to enter text.

Nominee’s Shirt Size:Click or tap here to enter text.(This will be needed if the nominee is selected as one of this year’s DUI Top Gun Award winners.)

3. Arrest Information:

Nominee’s Number of DUI Arrests in 2016: Click or tap here to enter text.

(Do not include arrests made as part of Sobriety Checkpoint operations)

Total DUI Arrests for entire Department in 2016: Click or tap here to enter text.

4. Department Information:

Call Volume of Department: Click or tap here to enter text.

Total No. Of Officers: Click or tap here to enter text.

Full Time: Click or tap here to enter text.Part Time:Click or tap here to enter text.

Does Your Department have a Traffic Safety Unit?Click or tap here to enter text.

Number of Officers Trained in SFST: Click or tap here to enter text.

5. Submitted by:

Your Name: Click or tap here to enter text.

Agency: Click or tap here to enter text.

Mailing Address: Click or tap here to enter text.

City/State/Zip: Click or tap here to enter text.

Phone: Click or tap here to enter text. Fax:Click or tap here to enter text.

Email Address: Click or tap here to enter text.

ONLY complete nominations will be accepted. Please make sure that the information in Section 1 is attached to the nomination form. All submissions must be postmarked bySeptember 8, 2017 and mailed to:

PA DUI Association, 2413 North Front Street, Harrisburg, PA 17110 ~

Fax - 717-238-6211 or email