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3.ASHHRA Board Nomination Form 2013 for 2014 Board

Thank you for your interest in serving as a member of the ASHHRA Board of Directors. If you have not already done so, go to www.ashhra.org and click on "About ASHHRA," then "Governance" to read the Board Charges.

To be considered as a candidate, this form must be completed by April 8, 2013. Next, please send your resume and photo to ashhra@aha.org.

Eligible members may submit information for more than one position. Please submit separate forms for each position.

1.Personal Information(Required.)

Name:

Organization:

Title:

Address 1:

City/Town:

State/Province:

ZIP/Postal Code:

Email Address:

Phone Number:

2.ASHHRA Board Position Sought for 2014:(Required.)

Vice President (3 year commitment)

At-Large Board Member

Non-Hospital Healthcare Director

Chapter Officer Director

3.If selected for the ASHHRA Board of Directors, I am available to attend the September 27, 2013 breakfast and board meeting prior to the Annual Conference in Washington, D.C. (Required.)

Yes

4.I have read the job description for the ASHHRA Board position for which I am applying and understand the time commitment required to serve as a member of the ASHHRA Board of Directors. I realize that volunteers must meet monthly deadlines, complete tasks, attend a variety of meetings/events, and ensure that the board remains focused on executing the ASHHRA Strategic Plan. I plan to manage my time in the following manner to ensure I meet the above needs along with the ASHHRA Board role expectations I am seeking:(Required.)

5.Work Experience
Please provide the positions/titles, dates of positions, organizations/agencies, and a brief summary of your duties starting with your present position.(Required.)

Position/title:

Organization:

Dates Employed From/To:

Brief summary of your duties:

Position/title:

Organization:

Dates Employed From/To:

Brief summary of your duties:

Position/title:

Organization:

Dates Employed From/To:

Brief summary of your duties:

6.List your special strengths, skills, or talents related to the board position you selected and how you would be effective in this role. Please give examples from past work and/or volunteer positions. (Required.)

7.Educational Preparation
Please provide the name of your School/College/University, location (city/state), and the degree granted & major.(Required.)

Name of School/College/University:

Location (City/State):

Degree granted & Major:

Name of School/College/University:

Location (City/State):

Degree granted & Major:

Name of School/College/University:

Location (City/State):

Degree granted & Major:

8.Briefly list by year your activities/accomplishments in ASHHRA at the local Chapter, Regional, and National levels. This may also include honors and recognition. (Required.)

9.Briefly list by year your activities/accomplishments of your membership in Local, State and National Organizations--OUTSIDE of ASHHRA (include offices held and dates). This may also include honors and recognition. (Required.)

10.Why are you the best qualified candidate for this position? (Personal statement to appear on ballot.) (Required.)

11.Please list three ASHHRA products and/or services you have utilized in the last year. Please be specific. This can include educational courses and events, services utilized, and/or products purchased through ASHHRA. (Required.)

12.How do you think you reflect the HR Leader competencies in your professional life?(Required.)

13.How would you like to reflect those HR Leader competencies on the ASHHRA Board of Directors?(Required.)

14.Why are you seeking this volunteer opportunity at this time?(Required.)

Thank you for your interest and support of ASHHRA. Your submission is much appreciated. Now please email your resume and photo to ashhra@aha.org with the subject "Applying for 2014 Board of Directors." Your submission will be acknowledged via email.

If you should have questions in the meantime, please email ashhra@aha.org or call 312-422-3720.