Board of Directors Questionnaire

Our Boards of Directors services is frequently retained to identify and evaluate potential Outside members for Boards of Directors, Boards of Trustees, and Boards of Governors of small, medium, and large organizations in both the private sector and public sector, nationally and internationally. If you have a personal interest in serving as a Board member, please complete the questionnaire below:

Once we receive your questionnaire we will contact you to schedule a personal interview.

First Name: *

Last Name: *

Company: *

Job Title: *

Address: *

City: *

Country: *

Postal Code: *

Phone: * #

Email: *

Are you currently on any Boards?:

If so, please submit the names, one in each line if many.

What is your function on these Boards? such as, Chairman:

Has your Board participation been active or passive?: *

Are you compensated for your Board activities? :

If so, just submit a range.

Do you travel to attend these Boards?: *

How many years have you served on Boards?: *

Have you been a part of a nominating committee for new Board members?: *

Yes

Have you been on any Boards outside your industry? What Industries?:

If so, please submit the names, one in each line if many.

Do you have any preferences in serving on nonprofit, Public Corporate or Private? : *

Are any of the Boards you are currently serving in need of Board members?:

If so, please submit the names, one in each line if many.

Resume:

Please attach your resume. Maximum file size upload of 800 KB.