Board of Directors Application

First Name*

Last Name*

Address*

Address Line 2

City*

State*

ZIP*

Email

Mobile Phone Number

Home Phone Number

Preferred Method of Contact

Home Phone
Mobile Phone
Email

Current Position

Current Employer

Please list relevant experience and/or employment.

Please attach your resume

Max. file size: 50 MB.

Who recommended you?

Please list any specialized training or certificates

Why are you interested in serving as a Board Member for BAMSI?

How do you feel BAMSI would benefit from your involvement on the Board?

How many hours per month could you commit to Board activities?

Do you have experience relative to BAMSI programs? If so, please explain.

Have you ever been employed by or provided volunteer services at BAMSI? If so, please explain

Please list all other community organizations, Boards, and committees that you currently serve on or have previously served on (business, civic, community, fraternal, political, professional, recreational, religious, social).

Please list organization, role/title, and dates of service.

Have you received any awards or honors that you would like to mention?

Skills, Experience, and Interests (please check all that apply)

Other Skills, Experience, and Interests

How did you hear about the Board volunteer opportunity?

I, the undersigned, assure that the information provided above is true and complete to the best of my knowledge and that I am over 18 years of age. To the best of my knowledge, I do not know any of any financial or business related party or other concern that would create a conflict of interest with my participation as a Board of Director. If there is a specific matter that may be a possible conflict of interest, please explain

I understand that I will be subject to a CORI (Criminal Offense Record Information) check and that I must attend a formal BAMSI Orientation. I also understand that any applicant holding a financial and/or business interest in BAMSI may not be eligible for Board membership, and as a member of the Board of Directors, I must refrain from voting on any matter when it is determined or questioned as to whether a conflict of interest exists.

Signature

Date

Name

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Board of Directors Application

Board of Directors Application

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