Preparing a nomination

Nominations of employees of WA state and local governments are made to the WA Public Service Medal Committee (the Committee).

Nominations must include the following:

1. Nomination form

  • The form is completed and submitted electronically.

2. Nomination statement

The statement:

  • is signed by the nominator and is no longer than two pages

  • gives a clear idea of how the nominee meets the criterion of outstanding service under the following headings:

  • Service: In what role(s) has the nominee excelled? Describe in detail the nature of the occupation, length of service and how the nominee’s contribution has exceeded expectations.

  • Achievement: How has the nominee demonstrated outstanding service? Has the nominee provided service excellence; shown innovation in program, project or policy development; provided excellence in leadership; and/or achieved more efficient processes, improved productivity or better service delivery? Detail key achievements that have resulted from the nominee’s involvement.

  • Impact: How has the nominee’s contribution had an impact on their organisation and its clients? What are the broader outcomes of the nominee’s work or the significance of the nominee’s efforts? How has their contribution had an impact on a particular field or community?

  • puts the nominee’s contribution into context so the Committee can assess how the nominee went ‘above and beyond’ what would normally be expected

  • does not assume the Committee knows the area in which the nominee is working or has worked, or understands the significance of their achievements and impact.

3. Referee statements

  • Nominations are accompanied by at least three signed referee statements providing comments on the services of the nominee. There is no limit to the number of referee statements.

  • It may also be appropriate to obtain referee statements from outside the public sector (for example, if the person is being nominated for outstanding service to a particular community or industry).

  • Each statement details specific examples of outstanding service by the nominee, be on official letterhead, signed by the referee and no more than two pages.

4. Endorsement by the nominee’s director general/chief executive officer

  • Nominations are accompanied by written proof of endorsement by the relevant director general/chief executive officer.

  • Contact the nominee’s agency/organisation to find out about seeking this endorsement.


All information in a nomination is treated as confidential.

If the nomination is successful, the nominee has the opportunity to advise whether they wish their address details to be published.

Page last updated 26 June 2019