APEX Application Submission

Employee Name*

First NameLast Name

Employee Number*

Department Number*

Department Name *

Job Title*

Category*

FTE*

Work E-mail*

Your E-mail Address

What discipline are you applying for?

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.

Additional Documents (PDF)

Notes

I certify that I meet all eligibility*

Employed at Salem Health in a 0.5 FTE or greater position for at least two yearsNo active corrective actions for the 12 month period preceding application submissionHold a position in an eligible job code

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*

Employee ID Number*

APEX Submission Form

APEX Application