Examiner Application

For informational purposes only.

Please submit your application and recommendations online at www.nist.gov/Baldrige by 2 p.m. EST on January x, 2011.

Baldrige National Quality Program National Institute of Standards and Technology •Department of Commerce

November 2010

The Baldrige National Quality Program is seeking applicants for its Board of Examiners. The board supports and evaluates the performance improvement of all types of organizations—businesses, schools, hospitals, and nonprofit organizations, including government agencies.

In support of the Baldrige National Quality Program, experts from around the United States give their time generously and enthusiastically as members of the board. Examiners make major contributions, both to the national effort to recognize and promote performance excellence and to their employing organizations that support their participation. Examiners evaluate organizations that are striving to serve as role models for the United States by applying for the Malcolm Baldrige National Quality Award.

The Program accepts Award applications from manufacturing, service, small business, education, health care, and nonprofit organizations. Coverage and balance within these sectors are important factors in selecting Examiners. Our goal is to ensure broad representation from many industries, companies, and organizations in the for-profit, nonprofit, and public sectors. We are particularly interested in potential Examiners who are physicians; dentists; senior managers; tenured professors in higher education; and K–12 teachers, principals, and superintendents. In addition, we are seeking applicants with expertise in finance, automotive manufacturing, food manufacturing, and nonprofit organizations (including charities and federal, state, and city agencies), as well as in the insurance, retail merchandising, construction, and hotel and hospitality industries.

Prospective Examiners (including those who have previously served on the board) must apply each year. To fulfill one of the basic aims of the Baldrige National Quality Program—expanding the United States’ base of knowledgeable, trained Examiners—a portion of the board is always reserved for new Examiners.

If you believe you are qualified, are willing to make a significant commitment of time and energy, want to help improve our country’s institutions, and want to benefit from the networking and educational experience of being an Examiner, we encourage you to apply to serve on the 2011 Board of Examiners.

Sincerely,

Harry S. Hertz

Director, Baldrige National Quality Program

Baldrige National Quality Program • NIST • 100 Bureau Drive, Stop 1020 • Gaithersburg, MD 20899-1020

Telephone (301) 975-2036 • Fax (301) 948-3716 • E-mail: baldrige@nist.gov • Web site: www.nist.gov/baldrige

Contents

The Malcolm Baldrige National Quality Award 1

About the Board of Examiners 1

Examiner Selection 2

Conditions of Involvement 3

Examiner Application Instructions 5

Examiner Application Form 6

Code of Ethical Conduct 15

North American Industrial Classification

System (NAICS) Codes 19

Paperwork Reduction Act Statement 22

Baldrige Criteria for Performance Excellence 1. Leadership 2. Strategic Planning 3. Customer Focus 4. Measurement, Analysis, and Knowledge Management 5. Workforce Focus 6. Process Management 7. Results

Please read the entire booklet before completing the application.

The Malcolm Baldrige National Quality Award

The Malcolm Baldrige National Quality Award, created by public law in 1987, is the highest level of national recognition for performance excellence that a U.S. organization can receive.

The Award was established to recognize organizations that demonstrate performance excellence. In addition, it aims to increase the understanding of the requirements for performance excellence. To accomplish this, the Award promotes information sharing on successful performance strategies and the benefits derived from implementation of these strategies.

The Department of Commerce is responsible for the Baldrige National Quality Program and the Award. The National Institute of Standards and Technology (NIST), an agency of the department, manages the Baldrige Program.

For more information about the Baldrige National Quality Award, please visit our Web site at www.nist.gov/baldrige.

About the Board of Examiners

The Board of Examiners comprises leading U.S. business, nonprofit, health care, and education experts selected from industry, professional and trade organizations, and government agencies and other nonprofit groups. Examiners take part in a comprehensive preparation course covering the Criteria for Performance Excellence, the scoring system, and the evaluation process (see Conditions of Involvement, page 3).

Application, Selection, and Appointment

Each fall, the Baldrige National Quality Program solicits applications from individuals to serve as Examiners for the following year. Examiners who have served on the board in previous years are required to reapply if they wish to serve again.

Each year, a number of Examiners rotate off the board to provide opportunities for others to participate. Due to the large number of applications, the Program may not be able to select some highly qualified applicants in a given year in order to create a balance of Examiners from different sectors and/or with different work experiences. Thus, we encourage past applicants who have not been selected to apply again.

The schedule for Examiner application and selection is as follows:

1. By January 7, 2011, 2:00 PM EST: Submit your application online.

2. By the end of March: The Program sends a letter indicating your selection status.

3. On receipt of notification letters: If you are selected, please return your confirmation notice immediately.

The Director of NIST appoints Examiners to serve for approximately one year beginning in April. Once appointed, Examiners are subject to the Conditions of Involvement and the Code of Ethical Conduct .

Training

Examiners attend training in Gaithersburg, Maryland You will be able to indicate your preferred dates when you are notified of your selection.

Confidentiality

All Examiner applications are confidential. In addition, the Program releases information on the successful strategies of Award recipients only after approval by the recipients.

Examiner Selection

The Baldrige National Quality Program seeks to constitute a board of experts who are capable of evaluating organizations eligible for the Malcolm Baldrige National Quality Award and who are willing to serve as representatives of the Program. Sector coverage and balance are important selection considerations. Board members are selected on the basis of their personal qualifications and are not considered representatives of their employers or any other organization. The Program attempts to ensure broad representation and minimize disproportionate involvement from one industry, sector, or organization.

Applications for the Board of Examiners are evaluated on the basis of the following factors.

Criteria Category Expertise

One evaluation factor is the extent of your experience in the seven Criteria Categories. Current or previous positions may demonstrate expertise in several Categories. For example, you may have supervised a large enough number of people to understand Workforce Focus (Category 5)., Significant production leadership experience may enable an understanding of Process Management (Category 6), and marketing expertise may facilitate an understanding of Customer Focus (Category 3).

Breadth and Depth of Experience

We also consider the extent to which you have in-depth experience in several industrial or service sectors or in health care, education, or nonprofit settings. (See the North American Industrial Classification System [NAICS] Codes at the end of this document.) Given the conflict-of-interest restrictions in assigning Examiners to evaluate applications, the Award Program gives preference to candidates with in-depth knowledge of more than one industry.

Specialized Expertise

Another evaluation factor is your knowledge or skill in areas of high need for the Program, such as health care, higher education, food service, restaurant management, food manufacturing, lodging and accommodations, retail merchandising, construction, finance and insurance, and automotive manufacturing. Senior managers, nonprofit leaders, physicians, dentists, and small business leaders are also needed. Your expertise may be demonstrated through formal studies and/or accomplishments, which may include relevant job experience, papers or articles written, research conducted, and degrees or certificates earned.

Knowledge, Skills, and Abilities

The following areas of knowledge, skills, and abilities have proven useful to Examiners: successful leadership experience; knowledge of strategic planning; customer service, human resource, and process management; skills in the use of statistical methods and evaluation of financial results; analytical ability (particularly as it applies to evaluating an organization); the ability to communicate both orally and in writing; interpersonal skills (which enable Examiners to serve as effective team members); and skills in using technology tools and resources (including e-mail, Internet-based tools, and word-processing software) to manage and communicate professional information.

Conditions of Involvement

Duties

Examiners review, analyze, and score written applications. They prepare the final scorebooks that are the foundation for written feedback reports to applicants. They also participate in an Independent and Consensus Review and may participate in a site visit. In addition to their application review responsibilities, board members contribute significantly to the Baldrige National Quality Program’s outreach and educational efforts by serving as representatives of the Program.

Eligibility

Examiners must be citizens or permanent residents of the United States with their primary residence in the United States or its territories. No applicant is denied consideration or appointment as an Examiner on the grounds of race, creed, color, national origin, age, sex, or disability.

Terms and Conditions of Appointment

(1) Application

To apply for appointment to the Board of Examiners, you must submit a completed application electronically by 2:00 p.m. EST, January 7, 2011. First-time Examiners must also provide two recommendations.

You will receive a letter electronically or via overnight mail informing you of your selection status. If you find after submitting an application that you would be unable to accept an appointment if offered, please withdraw the application immediately by calling the Baldrige Program at (877) 237-9064.

(2) Code of Ethical Conduct

As a board member, you will be expected to carry out your duties and responsibilities in the Award process in accordance with the Code of Ethical Conduct. (See the application.)

(3) Disclosure of Conflicts of Interest

If you are selected to serve on the board, you must provide information that allows the Program to determine conflicts of interest with Award applicants to which you may be assigned. Information disclosed includes, but is not limited to, employers, financial interests, and client relationships. The Program uses this information only to assign Examiners to applications and otherwise keeps the information confidential.

(4) Term of Appointment

Examiners are appointed for approximately one year, beginning in April.

(5) Time Commitment

As you apply for the board, please give careful consideration to the time commitment required to meet the Award application review schedule. Reviewing an application requires a minimum of 15 days from April to December (see the table below). If selected, you will be provided with specific dates and deadlines for work assignments, which will allow you to set aside time to meet your commitments. Even if your work requires temporary or extended travel or residence outside the United States, you must be able to accommodate your team’s schedule. You will be able to complete some portions of the work at your workplace or home. Business is conducted via overnight mail, telephone, secure fax, and secure Web. You will need to travel only for training and site visits. Award applicant’s place of business, if needed. ca requirements will not serve as Examiners.

Timeline and Time Commitment
Dates	Examiners Involved	Activity	Approximate Time Commitment
April–May	All Examiners	Self-study and classroom training	40–60 hours of prework 3–4 days of training in Maryland
June–July		Independent Review	35–45 hours
August–September		Consensus Review (including planning, preparation, consensus calls, and postcall work)	25–35 hours
September–October	20–25% of Examiners	Site visit preparation	10–20 hours
October		Site visit	6–7 days, 14–16 hours per day

Activity o Stage

Conditions of Involvement (continued)

(6) Adherence to Award Processes

As a board member, you will be expected to meet all requirements associated with a fair and competent applicant evaluation. This includes using the Criteria for Performance Excellence and the corresponding scoring system, adhering to the evaluation processes, meeting site visit requirements, and avoiding conflicts of interest. Thorough documentation and written communication are essential parts of the review process.

(7) Assignment of Board Members

The Program seeks to provide the fairest, most competent evaluation of each Award application.

Accordingly, you will be assigned to an application based on your knowledge and experience, consistent with the requirements to avoid conflicts of interest, apportion the application load equitably, and adhere to agreed-on schedules. Overall participation of board members varies depending on the results of the Consensus Review.

(8) Employer Contributions and Examiner Subsidy Policy

By supporting your time and travel/lodging expenses, your employer has a unique opportunity to be recognized, make a contribution to the competitiveness of U.S. organizations, and support the significant leadership development experience you receive as a Baldrige Examiner. Employers who sponsor their Examiner will be recognized in the Presidential Award Ceremony Program for the year in which the Examiner serves on the board. On request, the Baldrige Program will send a letter to the employers of selected Examiners to solicit their support and subsequently to acknowledge the support.

If your employer cannot make this commitment, the Foundation for the Malcolm Baldrige National Quality Award has limited funds available to subsidize the costs of travel and lodging. Subsidies are available as follows for Examiners and Senior Examiners:

1. Coach-class airfare or costs of other modes of transportation to the Washington area will be reimbursed up to $500. If the cost of an airline ticket or other mode of transportation exceeds this amount, costs will be reimbursed up to the $500 limit.

2. Lodging at the designated hotel will be reimbursed at the Baldrige room rate.

This year, Alumni Examiners may request reimbursement of up to $500 total for the cost of transportation to the Washington area and lodging at the designated hotel at the Baldrige room rate if other sources of support are not available. The Baldrige Program continues to provide all Examiners with training at no cost as well as breakfast and lunch each day of training and dinner on Wednesday evening.

Examiner Application Instructions 2011

All Applicants

All prospective Examiners must complete and submit the application package through our online application system beginning November 12, 2010. The Program does not accept mailed or faxed copies. Submit your application online by 2:00 p.m. EST, January 7, 2011. You will receive a notification letter by the end of March.

First-Time Applicants

If you are a first-time applicant, please complete all sections of the online application:

• Personal Information

• Examiner Knowledge, Skills, and Abilities

• Criteria Category Expertise

• Employment History

• Education and Training

• How Did You Hear about the Board of Examiners?

• Baldrige or Related Assessment Experience

• Outreach Activities

• Self-Rankings

• Disclosure of Conflicts of Interest

• Code of Ethical Conduct

• Recommendation Forms

• Examiner Preparation Course Schedule

In the online system, you will be asked to identify two individuals who will complete the recommendation forms on your behalf. Recommenders must submit the completed form through the online application system by 2:00 p.m. EST, January 7, 2011.

Previous Applicants Who Have Never Served on the Board

If you applied last year but have never served on the Board of Examiners, you may simply update your application as needed. You must also submit two recommendation forms. You have the option of submitting two new recommendations or resubmitting recommendations from the prior year if they are still in our system. Recommenders must submit the recommendation form through the online application system by 2:00 p.m. EST, January 7, 2011.

Returning Examiners

If you are a returning Examiner, please update and review the following information using the online application system. You may access the Examiner Application system through the Baldrige Web site (www.nist.gov/baldrige).

• Personal Information

• Update to Employment Information

• Self-Rankings

• Disclosure of Conflicts of Interest

• Code of Ethical Conduct

• Examiner Preparation Course Schedule

To update your education and training information or Baldrige-related experience, send an e-mail to examappl@nist.gov.

.

Examiner Application Form 2011

OMB Clearance #0693-0006

Expiration Date: April 30, 2013

PERSONAL INFORMATION

 

 

 

Title  Mr.  Ms.  Mrs.  Dr.

Last name

First name

M.I.

Home Address Street

 

Date of birth

mm       dd      

 

Place of birth

 

City, state, zip

 

U.S. citizen?

Yes No

Preferred address?

Work Home

Permanent resident visa?

Yes No

Please do not use a post office box number. List your work address under Primary Employer on the Employment History form.

Federal law requires Examiners to be U.S. citizens or hold a permanent resident visa.

Phone Numbers

Work

 

Home

 

Cell

 

Preferred Phone:

Work Home Cell

Fax

Home

Preferred Fax:

Work Home

Work

 

 

E-mail

Alternate e-mail

 

List up to 5 NAICS codes most relevant to your expertise. (See the last page of this document.)

  ,

  ,

  ,

  ,

  , .

If you have been a national Baldrige Examiner previously, list the year(s) you have served.

  ,

  ,

  ,

  .

May we send your name to the state award programs as a potential examiner?

 Yes

 No

 Already involved

 

 

Preferred first and last name for training nametag

Preferred first and last name for training certificate (You may include one degree or credential.)

EXAMINER KNOWLEDGE, SKILLS, AND ABILITIES

See page 2 for more information. For questions 1–4, select the best description of your professional experience.

1. Which of the following best describes your strategic planning experience?

As a strategic planning expert, I established strategic plan objectives and action plans, and I measured these plans using key performance measures or indicators.

I led strategic planning over a number of years or with a variety of organizations.

I have participated substantially in the strategic planning process.

I have had limited participation in the strategic planning process.

I have no experience in the strategic planning process.

2. Which of the following best describes your experience designing work systems and managing and improving work processes for implementing those work systems?

I am a recognized expert in work system design and work process management.

I have significant experience in work system design and work process management.

I have direct involvement in the design and delivery of my organization’s key processes.

I have a substantial educational background and/or substantial training in process management.

I have no experience in process management.

3. Which of the following best describes your experience engaging, managing, and developing an organization’s workforce?

I have held one or more leadership or supervisory positions, and I have made organization-wide decisions regarding employee recruitment, engagement, startups, downsizing, training, development, and/or safety.

I have supervised a large enough group of employees to understand workforce engagement approaches and issues.

I have had first-line supervisory responsibility for implementing training and/or workforce policies.

I have had training in workforce policies and practices.

I have no experience in workforce policies and practices.

4. Which of the following best describes your experience with systematic processes and formal methodologies for determining customer/student/patient satisfaction, customer/student/patient relationships, market knowledge, and customer/student/patient/stakeholder requirements?

As an expert in this field, I routinely determine the requirements of key customer processes, design and measure processes that meet these requirements, and improve processes to achieve better performance.

I have had significant experience with customer relationship management processes in a variety of settings over a number of years.

I have implemented and improved customer relationship and management processes and methodologies.

I have had formal education or training in these processes and methodologies.

I have no experience in these processes and methodologies.

EXAMINER KNOWLEDGE, SKILLS, AND ABILITIES (continued)

Your responses may not exceed 1,300 characters per question, including letters, numbers, punctuation, and spaces. You may copy and paste this text from other electronic files; however, any text exceeding 1,300 characters may be lost. Your essay responses will serve as evidence of your writing skills, a critical competency for Examiners.

5. The ability to “analytically” examine an Award application is an important skill. Please describe your experience in selecting relevant information, analyzing it, and synthesizing it into a concise presentation.

5. The ability to convey your thoughts clearly and concisely in speaking and writing is a valuable skill in the evaluation process. It is also important in promoting and representing the Baldrige National Quality Program. Please describe your accomplishments in both oral and written communication by citing specific examples of your most recent and/or relevant experience.

5. The Baldrige Award evaluation process is team-based, especially at the consensus and site visit stages. Please briefly describe your experience on teams and the reasons you are an effective team member.

5. Please tell us why you want to become a national Baldrige Examiner.

CRITERIA CATEGORY EXPERTISE

Describe your work experience that qualifies you, from the perspective of an Award applicant, to evaluate an organization in each of the Criteria Categories. Please do not include experience evaluating other organizations within a state or internal quality award program. Your responses may not exceed 1,300 characters per question. You may copy and paste this text from other electronic files. However, any text exceeding 1,300 characters may be lost. Your essay responses will serve as evidence of your writing skills, a critical competency for Examiners.

1. Within the Baldrige framework, the leadership triad emphasizes the importance of a leadership focuson strategy and customers/patients/students. Describe your work/personal experience, knowledge, and involvement that qualifies you to examine and provide feedback to an organization on these areas. This description should support your responses to questions 1 and 4 on the Examiner Knowledge, Skills, and Abilities form.

2. Within the Baldrige framework, the results triad focuses on an organization’s employees and key processes to accomplish the work that yields business/health care/student learning results. Describe your work/personal experience, knowledge, and involvement that qualifies you to examine and provide feedback to an organization on these areas. This description should support your responses to questions 2 and 3 on the Examiner Knowledge, Skills, and Abilities form.

EMPLOYMENT HISTORY

Working in reverse chronological order from your most recent or current position, describe your last 15 years of employment—or your last five positions if they cover a longer period.

Employer #1 (Primary Employer)

Company

 

Number of employees

 

Primary employer?

 Yes  No

Parent company (Enter “None” if no parent company exists.)

 

Number of employees

 

Address Do not use addresses with post office box numbers.

     

     

City/state/zip

 

Dates of service (mm/yyyy)

 

to

 

 Full-time  Part-time  Retired

Are you eligible to receive a company-funded pension based on your employment with this company?  Yes  No

Organization type (Please check all that apply.)

 Small business ( 500 or fewer employees)

 Health care

 Early childhood/secondary education

 Service

 Government

 Higher education

 Manufacturing

 Independent consultancy

 Other education

 Nonprofit

 Othertype

 

Job title

 

Number of employees supervised

 

Your supervisor’s name and title

 

Employer #2

Company

 

Number of employees

 

Parent company (Enter “None” if no parent company exists.)

 

Number of employees

 

Address (Do not use addresses with post office box numbers.)

     

     

City/state/zip

 

Dates of service (mm/yyyy)

 

to

 

 Full-time  Part-time  Retired

Are you eligible to receive a company-funded pension based on your employment with this company?  Yes  No

Organization type (Please check all that apply.)

 Small business (500 or fewer employees)

 Health care

 Early childhood/secondary education

 Service

 Government

 Higher education

 Manufacturing

 Independent consultancy

 Other education

 Nonprofit

 Other type

 

Job title

 

Number of employees supervised

 

Your supervisor’s name

 

EMPLOYMENT HISTORY (continued)

Employer #3

Company

 

Number of employees

 

Parent company (Enter “None” if no parent company exists.)

 

Number of employees

 

Address Do not use addresses with post office box numbers.

     

     

City/state/zip

 

Dates of service (mm/yyyy)

 

to

 

 Full-time  Part-time  Retired

Are you eligible to receive a company-funded pension based on your employment with this company?  Yes  No

Organization type (Please check all that apply.)

 Small business (500 or fewer employees)

 Health care

 Early childhood/secondary education

 Service

 Government

 Higher education

 Manufacturing

 Independent consultancy

 Other education

 Nonprofit

 Other type

 

Job title

 

Number of employees supervised

 

Your supervisor’s name

 

Employer #4

Company

 

Number of employees

 

Parent company (Enter “None” if no parent company exists.)

 

Number of employees

 

Address (Do not use addresses with post office box numbers.)

     

     

City/state/zip

 

Dates of service (mm/yyyy)

 

to

 

 Full-time  Part-time Retired

Are you eligible to receive a company-funded pension based on your employment with this company? Yes  No 

Organization type (Please check all that apply.)

 Small business (500 or fewer employees)

 Health care

 Early childhood/secondary education

 Service

 Government

 Higher education

 Manufacturing

 Independent consultant

 Other education

 Nonprofit

 Other type

 

Job title

 

Number of employees supervised

 

Your supervisor’s name

 

EMPLOYMENT HISTORY (continued)

Employer #5

Company

 

Number of employees

 

Parent company (Enter “None” if no parent company exists.)

 

Number of employees

 

Address (Do not use addresses with post office box numbers.)

     

     

City/state/zip

 

Dates of service (mm/yyyy)

 

to

 

 Full-time  Part-time  Retired

Are you eligible to receive a company-funded pension based on your employment with this company?  Yes  No

Organization type (Please check all that apply.)

 Small business (500 or fewer employees)

 Health care

 Early childhood/secondary education

 Service

 Government

 Higher education

 Manufacturing

 Independent consultancy

 Other education

 Nonprofit

 Other type

 

Job title

 

Number of employees supervised

 

Your supervisor’s name

 

EDUCATION AND TRAINING

Institutions attended (starting with the most recent)
	Institution, city, state		Degree/certificate		Dates attended
1.	 		 		 
2.	 		 		 
3.	 		 		 
Other Training
	Course topic		Provider		Dates attended
1.	 		 		 
2.	 		 		 
3.	 		 		 

How Did You Hear About the Board of Examiners?

Select all that apply.
 Association newsletter	Which association?	 
 Other Baldrige Program materials	Which materials?	 
 Conference/sponsor	Which conference/sponsor?	 		Specify Conference:
 Publication/e-mail announcement	Which publication?	 		If you selected “Other,” please specify:
 Web site advertisement	Which Web site?	 		If you selected “Other,” please specify:
 Baldrige Examiner brochure mailing
 Involvement in a state or local award program
 Referral by a current Baldrige Examiner
 My professional association’s Web site or listserv
 Have you ever applied to be a national Baldrige Examiner before?  Yes  No If so, please list the years.     ,     ,     ,     .

BALDRIGE OR RELATED ASSESSMENT EXPERIENCE

Although not required, previous Baldrige-like assessment experience is helpful for Examiners. Please describe your experience evaluating or preparing applications for internal, state or local, international, association, or other organizational award programs. Also include experience with internal or supplier assessment processes based on the Baldrige Criteria. Please include the name of the program, your role (Examiner, feedback writer-editor, application author, program director, consensus or site visit leader), and the number of years served with each program.
	Program		Role		Number of years of involvement Years of Involvement
1.	 		 		 
2.	 		 		 
3.	 		 		 
4.	 		 		 

Outreach Activities

Please list professional and other organizations with which you are affiliated, and indicate the nature of your affiliation. Also indicate how you have assisted these organizations with outreach activities, including presentations or articles you have completed on behalf of these groups.
	Organization and affiliation		Outreach activities
	 		 
	 		 
	 		 
	 		 

SELF-RANKINGS

Please rank from 1 (highest) to 7 (lowest) your ability to evaluate applications in the following areas. (Use each number only once.)
	 	Leadership
	 	Strategic Planning
	 	Customer Focus
	 	Measurement, Analysis, and Knowledge Management
	 	Workforce Focus
	 	Process Management
	 	Results

Please rank from 1 (highest) to 7 (lowest) your abilities in the following areas. (Use each number only once.)
	 	Expertise in the management of business, education, health care, or nonprofit organizations
	 	Expertise in the analysis of results in business, education, health care, or nonprofit organizations
	 	Knowledge of practices and improvement strategies leading to performance excellence
	 	Writing skills
	 	Leadership skills
	 	Interpersonal skills
	 	Education or training skills

Please rank from 1 (highest) to 8 (lowest) your ability to evaluate applications in the following areas. (Use each number only once.)
	 	Manufacturing business
	 	Service business
	 	Small manufacturing business (500 or fewer employees)
	 	Small service business (500 or fewer employees)
	 	Health care organization
	 	Early childhood through secondary education
	 	Postsecondary education
	 	Nonprofit organization

Disclosure of ConflictS of Interest

Members of the Malcolm Baldrige National Quality Award Board of Examiners shall voluntarily disclose to the administrators of the Award the identity of employers, competitors, key customers, key suppliers, and clients—past, present, or potential—whose interest might be favorably or unfavorably affected by the Examiner’s actions while acting as a member of the board. This includes disclosure of companies in which board members have financial holdings affiliations that may present or seem to present a conflict of interest for the board member Members of the Board of Examiners will be asked to provide signed statements before attendance at one of the Examiner Preparation Courses. Any material misstatement of fact in this application or incomplete disclosure of conflicts of interest shall be grounds for disqualification from the review process or dismissal from the Board of Examiners. In addition, Examiners agree to update their employment, financial, and client records periodically throughout their appointment. I certify that I have read and understand the above statement.
	Electronic signature required
	Signature of applicant		Date

Code of Ethical conduct

Members of the Malcolm Baldrige National Quality Award Board of Examiners pledge to uphold their professional principles in the fulfillment of their responsibilities as defined in the administration of Public Law 100-107, the Malcolm Baldrige National Quality Improvement Act of 1987, which establishes the Malcolm Baldrige National Quality Award.

Board members will be guided by four principles: integrity, professional conduct, confidentiality, and respect for intellectual property. In promoting high standards of public service and ethical conduct, they will

• conduct themselves professionally, guided by truth, accuracy, fairness, respect, and responsibility in all their interactions

• avoid representing conflicting or competing interests, or placing themselves in such a position where their interest may be in conflict—or appear to be in conflict—with the purposes and administration of the Award

• safeguard the confidences of all parties involved in the judging or examination of present or former applicants

• protect confidential information and avoid disclosures that may in any way influence the Award integrity or process, currently or in the future

• not serve any private or special interest in their fulfillment of the duties of a Judge or Examiner, therefore excluding by definition the examination of any organization or subunit of an organization that employs them or has a consulting arrangement in effect or anticipated with them

• not serve as Examiners of a primary competitor or customer or supplier of any organization (or subunit of an organization) that employs them, that they have a financial interest in, or with which they anticipate a consulting arrangement, or are otherwise involved

• not intentionally communicate false or misleading information that may compromise the integrity of the Award process or decisions therein

• make it clear, when establishing links from their own Web sites to the NIST or BNQP Web sites, that users will be taken to the official NIST Web sites

• acknowledge the use of trademarks owned by NIST, including those for NIST, The Quest for Excellence, and the Malcolm Baldrige National Quality Award, along with a statement indicating the trademark is registered by the National Institute of Standards and Technology

• never approach an organization they have evaluated for their personal gain, including the establishment of an employment or consulting relationship, and, if approached by an organization they have evaluated, not accept employment from that organization for a period of five years after the evaluation

• maintain and safeguard fairness in the examination process and the confidentiality of all Award application information, including the identity of applicants

• treat as confidential all information about the applicant and the applicant’s operation gained through the evaluation process, and take the following precautions:

• Applicant information is not discussed with anyone, including other Examiners, with the exception of designated team members, Judges, the Award Administrator, and NIST representatives. This includes information contained in the written application, as well as any additional information obtained during a site visit.

• Names of applicants are not disclosed during or after the application review process.

• No copies of application information are made or retained. (ASQ will notify Examiners when to return materials.)

• No notes, written or electronic, pertaining to the application are retained. (ASQ will notify Examiners when to destroy all notes.)

• Applicant-specific information can be discussed via cellular phone, cordless phone, and VoIP if authorized by the applicant. However, applicant names are not used within print or discussions.

• Electronic exchanges are only through an encrypted, secure Web site designated by NIST.

• No applicant information is adapted and/or used subsequent to the review process, unless the information is publicly released by the applicant (at the annual Quest for Excellence Conference, for example).

• Examiners do not reveal or discuss with other Examiners, either during training or during the application review phases, their participation with an organization in the preparation of an Award application.

• during Independent Review, personally and independently evaluate and score all assigned applications

• during Independent and Consensus Reviews, not communicate with applicant organization, or in any manner seek additional documentation, information, or clarification about the applicant’s organization. This restriction includes Internet searches. At Site Visit Review, the site visit Team Leader will communicate with the applicant.

• during the entire evaluation cycle use only applicant-specific information provided by the applicant. Not at anytime use independently gathered information on the applicant, e.g. from the press, web sites, or other social media.

• not at anytime (during or after the evaluation cycle) independently give feedback to applicants regarding scoring or overall performance

• upon completion of the Examiner Preparation Course, be able to use the following designation: Examiner, Malcolm Baldrige National Quality Award (MBNQA), and year(s) served. However, board members may not use the MBNQA logo in advertising or promotion or use business cards including the Examiner designation or the MBNQA logo.

• during the consensus and site visit processes, encourage and maintain a professional working environment that promotes respect for the Award applicants, their employees, and all members of the Examiner team

• when participating in a site visit, respect the climate, culture, and values of the organization being evaluated

Furthermore, board members enhance and advance the Malcolm Baldrige National Quality Award as it serves to stimulate American companies and organizations to improve quality, productivity, and overall performance. All board members pledge to abide by this Code of Ethical Conduct.

I agree to abide by the Code of Ethical Conduct.
	Print your name.
	Electronic signature required
	Signature		Date

Recommendation Form – must be completed online

Applicants who have never served on the board must include the names of recommenders in the forms in the online application. Providers of recommendations will receive an e-mail with instructions for completing the online forms.

  has applied to be a member of the 2011 Board of Examiners for the Malcolm Baldrige National Quality Award and has indicated that you will provide a recommendation.

Examiners evaluate applicants for the Malcolm Baldrige National Quality Award based on the Criteria for Performance Excellence. Examiners review, analyze, and score written applications and prepare the final scorebooks that are the basis for feedback reports to applicants. They also participate in team consensus evaluations and visits to the applicant’s site. In doing so, Examiners are required to have expertise in business, education, or health care management processes and results; have knowledge of practices and improvement strategies leading to performance excellence; possess and use good analytical, writing, and oral communication skills; and work as team members. Examiners must meet the highest standards of qualification and peer recognition.

Please provide a recommendation relating to your knowledge of the applicant’s qualifications to be an Examiner. Complete the online recommendation form no later than 2:00 PM, EST, January 7, 2011.

Using your peer group (professional colleagues) as a basis for comparison, please rank the applicant’s knowledge in the following categories, which are drawn from the Baldrige Criteria for Performance Excellence.
	Don’t Know	Bottom 50%	Top 50%	Top 25%	Top 10%	Top 1%
1. Leadership						
2. Strategic Planning						
3. Customer Focus						
4. Measurement, Analysis, and Knowledge Management						
5. Workforce Focus						
6. Process Management						
7. Results						

Using your peer group (professional colleagues) as a basis for comparison, please rank the applicant’s ability in the following areas.
	Don’t Know	Bottom 50%	Top 50%	Top 25%	Top 10%	Top 1%
1. Expertise in the management of business, education, health care, or nonprofit organizations						
2. Expertise in the analysis of results in business, education, health care, or nonprofit organizations						
3. Knowledge of practices and improvement strategies leading to performance excellence						
4. Writing skills						
5. Leadership skills						
6. Interpersonal skills						
7. Education or training skills						

Recommendation Form (continued)

Applicant		 			Applicant’s phone no.	 
Recommendation provider			 
Title	 				Provider’s phone no.	 
Employer	 				Years you have known applicant	 
Please evaluate the applicant’s qualifications to be an Examiner.  

On the applicant’s request, the Baldrige National Quality Program will make this recommendation available to the applicant.

Recommendation provider’s signature	Electronic signature required	Date

North American Industrial Classification System (NAICS) Codes

Include the NAICS codes that are most relevant to your area(s) of expertise in your online application.

To access the NAICS codes online, see www.census.gov/epcd/www/naics.html.

Code Sector

111 Crop Production

112 Animal Production

113 Forestry and Logging

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 Speciality Trade Contractors

311 Food Manufacturing

312 Beverage and Tobacco Product Manufacturing

313 Textile 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

Code Sector

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

Code Sector

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 Care 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

999 Unclassified Establishments

Baldrige National Quality Program

National Institute of Standards and Technology

United States Department of Commerce

Administration Building, Room A600

100 Bureau Drive, Stop 1020

Gaithersburg, MD 20899-1020

Telephone: (301) 975-2036 • Fax: (301) 948-3716

E-mail: baldrige@nist.gov • Web site: www.nist.gov/baldrige

The National Institute of Standards and Technology (NIST), an agency of the U.S. Department of Commerce, manages the Baldrige National Quality Program. For more than a century, NIST has helped to lay the foundation for the innovation, economic growth, and quality of life that Americans have come to expect. NIST promotes U.S. innovation and industrial competitiveness by advancing measurement science, standards, and technology in ways that enhance economic security and improve our quality of life. Through a network of nearly 400 assistance centers that serve all 50 states and Puerto Rico, NIST provides technical and business assistance to help smaller manufacturers overcome barriers to productivity and competitiveness.

Call the Baldrige Program or visit our Web site for

• information on improving the performance of your organization

• information on eligibility requirements for the Baldrige Award

• information on applying for the Baldrige Award

• information on becoming a Baldrige Examiner

• information on the Baldrige Award recipients

• individual copies of the Criteria for Performance Excellence—Business/Nonprofit, Education, and Health Care

• information on BNQP educational materials

• case studies

American Society for Quality (ASQ)

600 North Plankinton Avenue

Milwaukee, WI 53203

Telephone: (800) 248-1946 • Fax: (414) 272-1734

E-mail: asq@asq.org • Web site: www.asq.org

By making quality a global priority, an organizational imperative, and a personal ethic, the

American Society for Quality (ASQ) becomes the community for all who seek quality

technology, concepts, or tools to improve themselves and their world. ASQ administers the

Malcolm Baldrige National Quality Award under contract to NIST.

Call ASQ to order

• bulk copies of the Criteria

• Award recipients DVD

Paperwork Reduction Act Statement

This application contains collection of information requirements subject to the Paperwork Reduction Act (PRA). Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subject to penalty for failure to comply with, a collection of information subject to the requirements of the PRA, unless that collection of information displays a currently valid OMB Control Number. The estimated response time for this questionnaire is 60 minutes. The response time includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this estimate or any other aspects of this collection of information, including suggestions for reducing the length of this application to the National Institute of Standards and Technology; Attn., Dr. Harry Hertz; nqp@nist.gov; (301) 975-2361.

The OMB Control No. is 0693-0006, which expires on April 30, 2013.