Board of Directors

1. Contact Information

First Name

Last Name

Street Address

Apt/Suite/Office

City

State

Zip

Email Address

Phone Number

Mobile Phone

2. Preferred Method of Contact

Please enter an 'other' value for this selection.

3. Current Position

4. Current Employer

5. Please list relevant experience and/or employment.

6. Please attach your resume

File: {{filename}} delete

7. Who recommended you?

8. Please list any specialized training or certificates

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

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

11. How many hours per month could you commit to board activities?

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

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

14. 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

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

16. Skills, experience, and interests (Please check all that apply)

17. How did you hear about the board volunteer opportunity?

18. 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 of any financial or business related party or other concern that would create a conflict of interest with my participation on the Board of Directors. If there is a specific matter that may be a possible conflict of interest, please explain

19. 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.

Clear

Signature of

20. Date This question requires a valid date format of MM/DD/YYYY.

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Board of Directors

Board of Directors Application