Survey

1. Personal Information

Personal Information Name:
Organization:
Title:
Address 1:
City/Town:
State/Province:
ZIP/Postal Code:
Country:
Email Address:
Phone Number:

2. How many years have you worked in HR and/or a related field? Health care HR?

How many years have you worked in HR and/or a related field? Health care HR?

3. Areas of Volunteer Interest
Please select the area(s) and role(s) you would like to volunteer for. If you are interested in more than one area, please prioritize them (1,2,3, etc.)

	1	2	3	4	5	6
National Board of Directors	*Areas of Volunteer Interest Please select the area(s) and role(s) you would like to volunteer for. If you are interested in more than one area, please prioritize them (1,2,3, etc.) National Board of Directors 1	National Board of Directors 2	National Board of Directors 3	National Board of Directors 4	National Board of Directors 5	National Board of Directors 6
Regional Consultant (automatically on Regional, Chapter, and Member Services Committee)	Regional Consultant (automatically on Regional, Chapter, and Member Services Committee) 1	Regional Consultant (automatically on Regional, Chapter, and Member Services Committee) 2	Regional Consultant (automatically on Regional, Chapter, and Member Services Committee) 3	Regional Consultant (automatically on Regional, Chapter, and Member Services Committee) 4	Regional Consultant (automatically on Regional, Chapter, and Member Services Committee) 5	Regional Consultant (automatically on Regional, Chapter, and Member Services Committee) 6
National Advocacy Committee	National Advocacy Committee 1	National Advocacy Committee 2	National Advocacy Committee 3	National Advocacy Committee 4	National Advocacy Committee 5	National Advocacy Committee 6
National Learning and Education Committee	National Learning and Education Committee 1	National Learning and Education Committee 2	National Learning and Education Committee 3	National Learning and Education Committee 4	National Learning and Education Committee 5	National Learning and Education Committee 6
National Annual Conference Committee	National Annual Conference Committee 1	National Annual Conference Committee 2	National Annual Conference Committee 3	National Annual Conference Committee 4	National Annual Conference Committee 5	National Annual Conference Committee 6
National Subject Specific Task Forces	National Subject Specific Task Forces 1	National Subject Specific Task Forces 2	National Subject Specific Task Forces 3	National Subject Specific Task Forces 4	National Subject Specific Task Forces 5	National Subject Specific Task Forces 6

4. Speaking Opportunities
Please select the speaking venues you would like to volunteer for. If you are interested in more than one area, please prioritize them (1,2,3, etc.)

	1	2	3
ASHHRA Annual Conference & Exposition	*Speaking Opportunities Please select the speaking venues you would like to volunteer for. If you are interested in more than one area, please prioritize them (1,2,3, etc.) ASHHRA Annual Conference & Exposition 1	ASHHRA Annual Conference & Exposition 2	ASHHRA Annual Conference & Exposition 3
Webinars	Webinars 1	Webinars 2	Webinars 3
ASHHRA Chapter Leadership Conference	ASHHRA Chapter Leadership Conference 1	ASHHRA Chapter Leadership Conference 2	ASHHRA Chapter Leadership Conference 3
Regional Events	Regional Events 1	Regional Events 2	Regional Events 3

5. Publishing Opportunities
Please select the publishing opportunities you would like to volunteer for. If you are interested in more than one area, please prioritize them (1,2,3, etc.)

	1	2	3	4	5
HR Pulse (ASHHRA quarterly magazine)	*Publishing Opportunities Please select the publishing opportunities you would like to volunteer for. If you are interested in more than one area, please prioritize them (1,2,3, etc.) HR Pulse (ASHHRA quarterly magazine) 1	HR Pulse (ASHHRA quarterly magazine) 2	HR Pulse (ASHHRA quarterly magazine) 3	HR Pulse (ASHHRA quarterly magazine) 4	HR Pulse (ASHHRA quarterly magazine) 5
HR eNew Brief (ASHHRA monthly e-letter)	HR eNew Brief (ASHHRA monthly e-letter) 1	HR eNew Brief (ASHHRA monthly e-letter) 2	HR eNew Brief (ASHHRA monthly e-letter) 3	HR eNew Brief (ASHHRA monthly e-letter) 4	HR eNew Brief (ASHHRA monthly e-letter) 5
Books	Books 1	Books 2	Books 3	Books 4	Books 5
White Papers (articles about health care HR, management, research, practice, legal and legislative developments)	White Papers (articles about health care HR, management, research, practice, legal and legislative developments) 1	White Papers (articles about health care HR, management, research, practice, legal and legislative developments) 2	White Papers (articles about health care HR, management, research, practice, legal and legislative developments) 3	White Papers (articles about health care HR, management, research, practice, legal and legislative developments) 4	White Papers (articles about health care HR, management, research, practice, legal and legislative developments) 5
ASHHRA Website/Links	ASHHRA Website/Links 1	ASHHRA Website/Links 2	ASHHRA Website/Links 3	ASHHRA Website/Links 4	ASHHRA Website/Links 5

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

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

7. List your special strengths, skills, or talents related to the areas/roles you selected.

List your special strengths, skills, or talents related to the areas/roles you selected.

8. Describe your professional experience, especially as it is related to the areas/roles you selected.

Describe your professional experience, especially as it is related to the areas/roles you selected.

9. Educational Preparation
Please provide the name of your School/College/University, Location (city/state), and the degree granted & Major.

Educational Preparation Please provide the name of your School/College/University, Location (city/state), and the 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:
Name of School/College/University:
Location (City/State):
Degree granted & Major:

10. Briefly describe your activities/accomplishments in ASHHRA at the local Chapter level.

Briefly describe your activities/accomplishments in ASHHRA at the local Chapter level.

11. Briefly describe your activities/accomplishments in ASHHRA at the National and/or Regional levels.

Briefly describe your activities/accomplishments in ASHHRA at the National and/or Regional levels.

12. Briefly describe your activities/accomplishments of your membership in Local, State and National Organizations-OUTSIDE of ASHHRA (include offices held and dates).

Briefly describe your activities/accomplishments of your membership in Local, State and National Organizations-OUTSIDE of ASHHRA (include offices held and dates).

13. List all honors you have received (list the honors, dates and brief description of the reason for recognition).

List all honors you have received (list the honors, dates and brief description of the reason for recognition).

14. Time Management - Volunteers must meet deadlines and complete tasks so that expected services can be delivered to members on a timely basis. Please consider how the responsibilities of your volunteer position will fit with the demands of your job.

Time Management - Volunteers must meet deadlines and complete tasks so that expected services can be delivered to members on a timely basis. Please consider how the responsibilities of your volunteer position will fit with the demands of your job.

15. Please write a personal statement indicating why you are the best qualified candidate for this position. Please submit no more than a one-page document.

Please write a personal statement indicating why you are the best qualified candidate for this position. Please submit no more than a one-page document.

Thank you for your interest and support of ASHHRA. Your submission is much appreciated. Someone from the ASHHRA staff or a committee chair will contact you within the next 30 days.

If you should have questions in the meantime, please contact ASHHRA at:

E-MAIL: ashhra@aha.org
PHONE: 312-422-3720

1. ASHHRA Volunteer Interest Application