BGC Board of Directors Nomination Form 2021

Application Form

For your application to be considered you must:

complete the information requested on this form to the best of your ability, and
email your resume or curriculum vitae to NominationsCommittee@GoBGC.org.

If you have any questions, please contact the BGC office at (517) 853-5762 or email NominationsCommittee@GoBGC.org. Thank you.

Question Title

* 1. Contact Information

Name (First, MI, Last)

Prefixes (Ms, Mr, etc.)

Affixes (Jr., Sr., PhD, CIH, QEP, CSP, etc.)

ABIH/IPEP Certification Number

Address 1

Address 2

Address 3

City/Town

State/Province

Zip/Postal Code

Country

Email Address

Daytime Phone

Evening Phone

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* 2. What is the time zone for this address?

Eastern Time

Central Time

Mountain Time

Pacific Time

International (please specify your international time zone)

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* 3. Work Information

Job Title

Employer Name

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* 4. Describe your primary job responsibilities for your current position.

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* 5. About how long have you been in your current position?

Years

Months

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* 6. Type the number of years of work experience in each of the following areas:

Academic

Consulting

Government

Industry

Labor

Other (Describe with years experience)

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* 7. Bachelor's Degree

School

Major/Minor

Year Awarded

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* 8. Master's Degree (if applicable)

School

Subject Area

Year Awarded

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* 9. Doctoral Degree (if applicable)

School

Subject Area

Year Awarded

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* 10. List your professional certifications and the year achieved.

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* 11. Describe any professional leadership positions and achievements
(e.g., AIHA local sections, national level committees, certification boards, mentorship, etc.)

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* 12. Describe any community leadership positions and achievements.

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* 13. What do you believe are the major challenges and opportunities that BGC will face in the next four years?

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* 14. What contributions do you believe you could make as a member of the BGC Board of Directors to address these challenges or opportunities?

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* 15. Are you willing to attend three (3) weekend Board meetings per year and participate in 9 monthly conference calls?

Yes

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* 16. Are you willing and able to serve a four- (4) year term of office as a BGC credential holder or a two- (2) year term of office as a Public Member?

Yes

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* 17. Do you have your employer’s approval to make this time commitment?

Yes

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* 18. Do you have any business, professional, or personal activities that could constitute a conflict of interest with the work of the Board for Global EHS Credentialing? https://ehscredentialing.org/bod/bod-nomination/

Yes - Please describe:

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* 1. Contact Information

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* 2. What is the time zone for this address?

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* 3. Work Information

Question Title

* 4. Describe your primary job responsibilities for your current position.

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* 5. About how long have you been in your current position?

Question Title

* 6. Type the number of years of work experience in each of the following areas:

Question Title

* 7. Bachelor's Degree

Question Title

* 8. Master's Degree (if applicable)

Question Title

* 9. Doctoral Degree (if applicable)

Question Title

* 10. List your professional certifications and the year achieved.

Question Title

* 11. Describe any professional leadership positions and achievements(e.g., AIHA local sections, national level committees, certification boards, mentorship, etc.)

Question Title

* 12. Describe any community leadership positions and achievements.

Question Title

* 13. What do you believe are the major challenges and opportunities that BGC will face in the next four years?

Question Title

* 14. What contributions do you believe you could make as a member of the BGC Board of Directors to address these challenges or opportunities?

Question Title

* 15. Are you willing to attend three (3) weekend Board meetings per year and participate in 9 monthly conference calls?

Question Title

* 16. Are you willing and able to serve a four- (4) year term of office as a BGC credential holder or a two- (2) year term of office as a Public Member?

Question Title

* 17. Do you have your employer’s approval to make this time commitment?

Question Title

* 18. Do you have any business, professional, or personal activities that could constitute a conflict of interest with the work of the Board for Global EHS Credentialing? https://ehscredentialing.org/bod/bod-nomination/

* 11. Describe any professional leadership positions and achievements
(e.g., AIHA local sections, national level committees, certification boards, mentorship, etc.)