Shining Star/Employee of The Month Submission Form

This form allows Administrators to submit their Shining Star/Employee of The Month winners with ease.

Submittor Details
Submittor Name*

Enter your name.
Submittor Email*

Please enter your Alaris email so that we may contact you regarding this submission if need be.
Employee Details
Employee Name*
Employee Designations

Enter any designations, separated by commas, the employee might have, that will be displayed after their name (e.g. RN, LPN, etc.).
Month of Win*
Choose the month that the employee won.
Employee Position*

Enter the employees position title.
Facility*
Please select a facility.
When did the employee join Alaris or how long ago?*
Enter when the employee joined the facility (or how many years of service).
Employee Picture*
Drop files here or

Accepted file types: jpg, gif, png, jpeg, Max. file size: 100 MB, Max. files: 5.
Submit the employee's winning picture.

Submittor Details