CCIDC Board Member Application

Submit this form as well as your resume and a brief biography to apply to become a CCIDC Board Member. Qualified applicants will be required to attend a Board Orientation Webinar before the Selection Committee makes its final determination.

Name

First

Last

Phone

Website / URL

Address

Address Line 1

Address Line 2

City

State

Zip Code

Which Board position are you applying for?

Professional Member | Area of Expertise or Public Member

that Name any

What motivates you to seek a position as a CCIDC Board Member?

Please list any applicable skills you have that would be an asset to this position

Professional Organization/Club/Group Affiliation/Membership

Please list any Professional Organization/Club/Group you are affiliated with or a member of as well as your level of involvement (If None, type "None"). Please Provide: Organization Name | Affiliation/Membership Level | Involvement status

Upload your résumé

Drag & Drop Files, Choose Files to Upload

Upload a brief bio

Drag & Drop Files, Choose Files to Upload

This information will be used for Board Member Bios on the CCIDC website

Upload a current headshot

Drag & Drop Files, Choose Files to Upload

If selected, your headshot will be placed with your bio on the CCIDC website

Confidentiality Agreement Requirement for Board Members:

As the Board reviews and discusses sensitive matters, including employee-related issues, administrative concerns, and CID complaints, it is mandatory for all Board Members to sign the CCIDC Board Member Confidentiality Agreement.

Please review, sign, and submit the agreement via email to ccidcboard@ccidc.org prior to the Board Orientation.

Electronic Signature | Enter Full Name Below

By entering my name, I declare under penalty of perjury under the laws of the State of California that all information submitted is true, complete, and accurate. I acknowledge that false or incomplete information will result in immediate disqualification.

Date

Date Application Signed/Submitted to CCIDC