Today's Date (required)

Your Name (required)

Phone Number (required)

Your Email (required)

Address (required)

Preferred method of contact
EmailPhone

Current Position (required)

Current Employer (required)

Work Phone Number (required)

What BOD position/s are you applying for? (required)

Relevant Experience and/or Employment. Please attach resume. (required)

Of the following skills, which three would best describe your strengths that you feel can further the mission of the RTSO (required)
AdvocacyNon-profit experienceEvent planningFundraisingProgram evaluationStrategic planningGraphic design/technologyFinance/accountingPolicy developmentMinistry/government experienceSocial media/communicationsEducation/instructionGrant writingPublic relations

Other skills

Please list any other board or committees that you serve on currently, or in the past (include business, civic, community, political, professional, recreational, religious, and social)

Why are you interested in joining the RTSO board? (required)

Please list any other groups or organization that you could serve as a liaison on behalf of the RTSO.

Please share any other information you feel is important for consideration of your application.

Please review and respond to the following questions.

Are you aware of any information about yourself, which might tend to reflect unfavorably on your reputation, morals, character or ability as a board member for FYI?
YesNo
If yes and would like to explain

Have you ever been convicted of a criminal offence?
YesNo
If yes and would like to explain

By signing below and submitting, I attest that the information I have provided is true and correct. Additionally, my signature represents my agreement to the following statements: I understand and agree to the Respiratory Therapy Society of Ontario Board of Directors Expectations; I agree to participate pursuant to the Policies, Procedures and Bylaws of the Respiratory Therapy Society of Ontario Board; and I understand that if conflicts prevent me from performing the rules and expectations as a Board Member, I may be removed from the Board by a majority vote.

Signature (required)

Today's Date (required)