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ZS-DM01-R01
Complete this nomination form and then click the submit button at the bottom. Submitting the form results in an e-mail acknowledgement being sent to the nominee and the nominee's manager with a copy to the residency leader. Nominees must have the full approval and support of their managers before submitting this form. The more information you provide about your qualifications and experience, the greater your chances of being selected.
Nominees are typically employees of companies, organizations, or institutions. Nominees not meeting this criteria must be formally sponsored by a company, organization, or institution. A nominee employed by a self-owned company must prove in advance that it is a legally-registered business entity in its home Country.
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Please review the nomination checklist before filling out the following form.
The fields indicated with an asterisk (*) are required to complete this transaction; other fields are optional. If you do not want to provide us with the required information, please use the "Back" button on your browser to return to the previous page, or close the window or browser session that is displaying this page.
Basic Information
Salutation Mr. Mrs. Ms. Miss Dr.
First Name*
Last Name*
Position or Job Title*
Nominee's E-mail Address (if IBM employee, please enter EXACTLY as it appears in BluePages)*
Telephone Number
Fax Number
Company Name*
Company Address*
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Country* --Select-- Abu Dhabi Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia Botswana Bouvet Island Brazil British Indian Ocean Ter Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Islands Cayman Islands Central African Republic Chad Chile China China/Hong Kong Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo Dem Republic Cook Islands Costa Rica Croatia Cyprus Czech Republic Cote dIvoire (Ivory Coast) Denmark Djibouti Dominica Dominican Republic East Timor (Indonesia) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands (Denmark) Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar (UK) Greece Greenland (Denmark) Grenada Guadeloupe (France) Guam (USA) Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See (Vatican City State) Honduras Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakstan Kenya Kiribati Korea Kuwait Kyrgyzstan Lao Peoples Dem Republic Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique (France) Mauritania Mauritius Mayotte (France) Mexico Micronesia Fed States of Moldova Republic of Monaco Mongolia Montserrat (UK) Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Neth Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island (Australia) Northern Mariana Islands Norway Oman Pakistan Palau (USA) Palestinian Territory Occ Panama Papua New Guinea Paraguay Peru Philippines Pitcairn (UK) Poland Portugal Puerto Rico (USA) Qatar Romania Russia Rwanda Reunion (France) Saint Helena (UK) Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and Sandwich Spain Sri Lanka Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau (New Zealand) Tonga Trinidad Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates Uruguay USA UK Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands British Virgin Islands US Wallis and Futuna (France) Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe
Are you employed by a government agency?* --Select-- Yes No
Nominee's Manager*
Manager's E-mail Address*
Relationship with IBM* Client Business Partner Independent solution developer Member of educational institution Employee of IBM Employee of an IBM subsidiary Other
Type of IBMer (for IBM employees only) --Select-- IBMer in GBS Global Business Services IBMer in GTS Integrated Technology Services IBMer in GTS Strategic Outsourcing IBMer in GTS Other IBMer in Sales and Distribution IBMer in STG System i IBMer in STG Power IBMer in STG System z IBMer in STG Storage IBMer in STG Other IBMer in SWG IBMer in none of the above
IBM Contact's Name (for non-IBM employees only)
IBM Contact's Internet E-mail Address
How did you hear about this residency?* --Select-- from the IBM Redbooks website from the Weekly Newsletter from a colleague from a residency leader from a technical forum or conference from some other source
Skills
Scale is 1 = None, 2 = Limited, 3 = Average, 4 = Good and 5 = Excellent.
Documentation Skills
Social Media Skills
Qualifications and Experience*
Previous Residency Experience
Other Pertinent Information
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Password*
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