Jeb Stuart Rescue Squad Employee Portal
JEB STUART RESCUE SQUAD, INC.
BOARD OF DIRECTORS INTEREST FORM
Applicant Information
Full Name:
*
Address:
*
City, State, ZIP:
*
Phone:
*
Email:
*
Background
Current Occupation/Employer:
Education/Training:
Relevant Licenses or Certifications:
Experience and Skills (check all that apply)
Emergency Medical Services
Fire/Rescue Operations
Legal/Compliance
Nonprofit Leadership
Finance/Budgeting
Public Relations/Communications
Fundraising/Development
Strategic Planning
Human Resources
Other:
Statement of Interest
Please describe why you are interested in serving on the Board of Directors:
*
Availability and Conflicts
Can you commit to attending regular Board meetings (monthly/quarterly)?
*
Yes
No
Possibly
Have you ever been affiliated with Jeb Stuart Rescue Squad?
Yes
No
If yes, please provide details (dates, role, etc.):
Are you currently affiliated with Jeb Stuart Rescue Squad as a volunteer or paid staff member?
Yes
No
If yes, please describe your role:
Do you have any potential conflicts of interest to disclose?
Yes
No
If yes, please explain:
References
Reference 1
Name:
Phone:
Relationship:
Reference 2
Name:
Phone:
Relationship:
Certification
I certify that the information provided is true and complete to the best of my knowledge.
*
Submit Application