Diversity Recruitment Partners Advisory Board Application

Thank you for your interest in serving as a member of the Diversity Recruitment Partners Advisory Board. Please complete and submit this questionnaire as part of the application and selection process for the 2024-25 Advisory Board.

Privacy Act Statement

The information you provide will only be used by the Diversity Recruitment Partners Advisory Board Selection Committee to determine qualifications, suitability, and availability for service on Advisory Board.

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* 1. Personal Contact Information

Name

Address

Address 2

City/Town

State

ZIP/Postal Code

Email Address

Cell Phone Number

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* 2. Your LinkedIn URL

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* 3. Please upload your résumé here.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 4. Current Employer

Employer's Name

How Long at Employer?

Address

Address 2

City/Town

State

ZIP/Postal Code

Position/Title

Your Work Email Address

Your Work Phone Number

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* 5. List your business or professional experience NOT listed on your resume.

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* 6. Identify your area of expertise.

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* 7. Are you currently under investigation or charged of a felony, criminal action or unlawful act?

Yes

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* 8. Are you a US citizen?

Yes

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* 9. Affiliations, Representations, and/or Positions with Boards, Advisory Councils, or Similar Groups

List affiliations and/or service as a community leader that would benefit you in your role as a member of the Advisory Board.Please include relationships outside of your current employer in which you represent the interests of a party.

List all positions and relationships you currently hold or held at any time during the past years, whether or not you were compensated, and whether or not you currently hold that position. (Positions include an officer, director, trustee, general partner, proprietor, representative, executor, member, or consultant of any of the following:
- Corporation, partnership or business entity
- Nonprofit or volunteer organization
- Political entity

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* 10. I [STATE FULL NAME IN BOX BELOW] certify that the statements I have made on this form and all attached statements are true, complete, and correct to the best of my knowledge.

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* 11. Date application submitted

Date