Name

First Name

Last Name

Number of Years as a Member of FFCU

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Currently Employed?

Yes

No (Unemployed)

No (Retired)

Current (Most Recent) Employer

Current (Most Recent) Title

Number of Years at Current (Most Recent) Employer

Community Service - Current or Previous Board Level Experience (if applicable)

Organization Name

Position Held

Active Dates

Additional Community Service

Organization Name

Position Held

Active Dates

Additional Community Service

Organization Name

Position Held

Active Dates

Financial Services Experience

Have you ever held a position at a financial institution as an employee or volunteer?

Yes

If "Yes," please list financial institution(s) below:

Organization Name

Position Held

Address

Active Dates

Organization Name

Position Held

Address

Active Dates

Personal Statements

Why do you wish to become an Associate Board Member for the FFCU Board of Directors?

What special qualifications would you bring to the FFCU Board of Directors?

References - Please provide up to three professional references

Reference Name

Relationship

Email Address

Phone

Reference Name

Relationship

Email Address

Phone

Reference Name

Relationship

Email Address

Phone

Agreements to Serve

I certify that the information in this application is true and correct, and I authorize the FFCU Nominating Committee to investigate and verify any and all of the information included.

I understand the FFCU Nominating Committee will gather employment information considered necessary and appropriate.

I understand that the FFCU Nominating Committee will retain this application whether or not I qualify for nomination with the understanding that it will be held in the strictest of confidence.

I agree to serve if appointed by the FFCU Board of Directors.