APEX Application Submission

APEX Submission Form
Program

Welcome to the Acknowledging Professional Excellence (APEX) application. The APEX program at Salem Health Hospitals and Clinics celebrates and recognizes clinical professionals who demonstrate exemplary achievement in their roles, with a focus on those working directly with patients. This program promotes professional clinical practice through ongoing education, certification, clinical research, and continuous improvement. By supporting lifelong learning and professional growth, APEX aligns with our organizational values and commitment to excellence in patient care. Eligible employees may qualify for a one-time recognition award for their dedication to advancing clinical practice. Please review the following information carefully to ensure you meet the eligibility criteria and understand the steps required to complete the application process.

Eligibility
- Employed at Salem Health in a 0.5 FTE or greater position for at least two years
- No active corrective actions (does not include verbal warning or coaching), for the 12 month period preceding application submission
- Hold a position in an eligible job code (review APEX Policy)
Employee Name*

First NameLast Name
Department Number*
Department Name *
FTE*
Leader*
Job Code*
Work E-mail*
Your E-mail Address
Employee ID Number*
Job Title*
What category are you applying for?

Category 1Category 2Category 3Category 4
What discipline are you applying for?

Care ManagementDieteticsImagingLaboratoryNursingPharmacyRehabilitationRespiratoryMedical Tech
Have you been awarded an APEX award before?

YesNo
Upload APEX Application (PDF)*

If your APEX file is too large, please break it into two files and submit the second file below.
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Additional Documents (PDF)

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Notes
I certify*

I certify that I have included all necessary documents for my APEX application: APEX Manager Support Form, all required elements, all elective elements.
I understand*

I understand that my APEX application will be reviewed at the next APEX Committee meeting. This meeting occurs every third Tuesday of each month, and an email notification will be sent to you with the outcome in the following weeks. I understand processing for APEX applications can take up to 6 weeks due to the volume of applications received. I understand that failure to provide all necessary documents may result in a delay of my APEX
Signature*

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APEX Submission Form