Board of Directors Application - 2017

Application closes at 11:59pm MST  2/24/17

Board of Directors Application

PERSONAL INFORMATION















EMPLOYMENT HISTORY



Current Employer









Next Most Recent Employer









Next Most Recent Employer









BOARD OF DIRECTORS EXPERIENCE








PROFESSIONAL EXPERIENCE

LANGUAGES


Please rate your experience in the following areas, with 1 being lowest experience and 5 being highest experience.
1 2 3 4 5
Strongly Disagree Disagree Neutral Agree Strongly Agree

EDUCATION HISTORY

High School Vocational College/University
School Name
City/State/Zip
# of years completed
Did you graduate?
Degree/diploma earned:
Graduate Studies Other Military Service
School/branch name
City/State/Zip
# of years completed
Did you graduate?
Degree/diploma earned:

REFERENCES

1st Reference








2nd Reference








3rd Reference








Submission

By Submitting this application form, I certify that I have not purposely withheld any information that might adversely affect my chances for board service. I attest to the fact that the answers given by me are true and correct to the best of my knowledge and ability. I understand that any omission (including misstatement) of material fact on this application or on any document used to attain the position can be grounds for rejection of application and/or service. I understand that as a condition of service, Re:Vision may choose to do a background check. I permit Re:Vision to examine my references, records of employment, education, and other information I have provided. I authorize the references that I have listed to disclose any information related to my work record and my professional experience with them, without giving me prior notice of such disclosure. In addition, I release Re:Vision, my former employers and all other persons, corporations, partnerships, and associations from any and all claims, demands or liability arising out of or in any way related to such examination or revelation.

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