Public Service Credit Union Nomination Application

Nomination Application

PLEASE NOTE - ALL SECTIONS MUST BE COMPLETED
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Phone Number*
Email*
example@example.com
Member of the credit union since*
Date
Member #*
Are you bondable? (See Bond Application)*

YesNo
Have you filed for bankruptcy in last 7 years?*

YesNo
If yes when?

MonthDayYear
Date
Are you a person who is undischarged from bankruptcy?*

YesNo
Have you been an employee of the Public Service Credit Union within the last three years?*

YesNo
Are you an employee of a credit union or the guarantee corporation?*

YesNo
Are you a member of the auditing firm that audits the Public Service Credit Union?*

YesNo
Are you a parent, child, grandchild, spouse, brother, sister or in-law of an employee of Public Service Credit Union?*

YesNo
Are you the solicitor of Public Service Credit Union?*

YesNo
Have you been an employee of the Bargaining Agent for PSCU or a member of its Board of Directors within the past year?*

YesNo
Are you a public employee whose official duties are concerned with the business of credit unions?*

YesNo
Will you commit to comply with the Code of Corporate Ethics and Business Conduct for Directors?*

YesNo
Will you agree to participate in required Board / committee meetings?*

YesNo
Will you agree to serve on at least one of the Board’s standing committees and ad hoc committees as required?*

YesNo
Will you agree to complete the Director training program as prescribed by the training policies?*

YesNo
Do you have knowledge and experience in business matters and financial statements?*

YesNo
Do you have the ability to deal with business, financial and corporate issues?*

YesNo
Note: A Credit Bureau report will be obtained for completeness of nomination process. A certificate of conduct may be required by the bonding company if elected as a Director. Any regular cost incurred will be covered by the Credit Union.
By submitting this application you are authorizing the Nomination Committee to complete the necessary due diligence to ensure your eligibility as Director and authorize Public Service Credit Union to complete a credit bureau report. Additionally, you agree that you have read and understand the terms and conditions to be a Director as summarized above in this nomination package including the Fidelity Bond Application and accept liability for your decisions as a Director.
Name

Clear
Date*

MonthDayYear
Date
Should be Empty: