"Promoting Excellent Communities, Education, and Leadership"
www.operationxcel.org
Board of Directors Candidate Application
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
We need this information in order to run a background check
Gender
Ethnicity
Please upload your resume.
*
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Employer
Employer Name
Your Job Title
Employers Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employers Email
example@example.com
Employers Phone Number
Please enter a valid phone number.
Type of business or organization
Primary service(s) and area/population served
Boards or Committees
Please list boards and committees that you serve on, or have served on (business, civic, community, fraternal, political, professional, recreational, religious, social).
Organization Name
Role or Title/Dates Served
Organization Name
Role or Title/Dates Served
Organization Name
Role or Title/Dates Served
Education/Training/Certificates
Optional – Have you received any awards or honors that you’d like to mention?
How do you feel Operation Xcel would benefit from your involvement on the Board?
Skills, experience and interests (Please select all that apply)
Personnel, human resources
Administration, management
Nonprofit experience
Community service
Policy development
Program evaluation
Public relations, communications
Education, instruction
Special events
Grant writing
Fundraising
Outreach advocacy
Other
Please list any groups, organizations or businesses that you could serve as a liaison to on behalf of Operation Xcel.
Please tell us anything else you’d like to share.
References
List four references (not relatives) who have known you for at least one (1) year. We will email your references a form to fill out via email.
Reference #1 Name
*
First Name
Last Name
Reference #1 Phone Number
Please enter a valid phone number.
Reference #1 Email
*
example@example.com
Reference #1 Relation
*
Reference #2 Name
*
First Name
Last Name
Reference #2 Phone Number
Please enter a valid phone number.
Reference #2 Email
*
example@example.com
Reference #2 Relation
*
Reference #3 Name
*
First Name
Last Name
Reference #3 Phone Number
Please enter a valid phone number.
Reference # 3 Email
*
example@example.com
Reference #3 Relation
*
Reference #4 Name
*
First Name
Last Name
Reference #4 Phone Number
Please enter a valid phone number.
Reference #4 Email
*
example@example.com
Reference #4 Relation
*
Authorization for Release of Personal Data Record Information
The information contained in this application is correct to the best of my knowledge. I hereby authorize Operation Xcel and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/ investigative consumer report may include, but is not limited to the following areas: verification of social security number; current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records. I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to Operation Xcel or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources. I hereby release Operation Xcel, the Social Security Administration, and its agents, officials, representative, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may, at any time, result to me, my heirs, family, or associates because of compliance with this authorization and request to release. I understand that any false statements, withheld information or negative feedback from reference(s) will be reason(s) to disqualify me from volunteering with this agency.
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