Board of Directors Application

Associate Director Application

Biographical Data

Your Name

Last Name Middle Initial First Name

Business Phone

Cell Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Intandem Account Number

Years of Membership (if known)

Employment

Employer

Address

Title/Occupation

Type of Business

Length of Time Employed

Primary Duties

Previous Employer

Employer

Address

Title/Occupation

Type of Business

Length of Time Employed

Primary Duties

Education

School

Post Graduate

Degree/Area of Study

Under Graduate

Degree/Area of Study

References

Provide Two References: One from your current/former place of employment

Name

Relationship

Years Known

Phone Number

Name

Relationship

Years Known

Phone Number

Personal Statement

Personal statements are confidential

Why do you wish to become a volunteer Board member of Intandem Credit Union?

What education, background, or training have you had regarding financial institutions?

i.e., college courses, seminars, conferences, workshops, etc.

What interests, skills, knowledge, or strengths, do you bring to the position you are applying for, and how do you think they will benefit the credit union?

Additional Information/Questions

Have you ever been convicted of a criminal offense involving fraud, dishonesty, breach of trust or misrepresentation or pleaded no contest to said offense?

Have you had a judgment issued against you in a civil action involving fraud, dishonesty, breach of trust or misrepresentation?

Have you ever caused this credit union a financial loss?

Have you ever had bond coverage modified or revoked, or an application for a bond denied?

Have you ever been removed from office by any regulatory or governmental agency while acting as an officer, agent, employee, consultant, or representative of any financial institution?

Have you ever been personally subject to an operating directive for cause while serving as an officer, director, or senior executive manager of any financial institution?

Are there any legal, administrative, or civil proceedings pending against you?

Are you a member of the immediate family of any director or employee of Intandem Credit Union?

Are you an employer, employee, supervisor, or subordinate of any employee or director?

Are you now or have you ever been an employee of Intandem Credit Union or an owner, employee, or official at any financial institution (banks, brokerages, mutual fund companies, credit unions) or their trade associations, advisory councils/boards, committees, commissions, or any other such group?

Have you read and understood the Job Description?

Do you possess the qualifications described in the Job Description and can you meet the responsibilities listed?

Are you willing to complete education and/or attend conferences, seminars, workshops, etc. related to the duties of a credit union volunteer on your own time? Registration and travel expenses are paid by the Credit Union per the current Travel Policy. Education courses comprise fewer than five hours of online learning for new volunteers, and about an hour per year after.

Have you been reported to the credit bureaus as delinquent on any financial obligations in the past 24 months?

Have you filed for bankruptcy in the past 7 years?

Will you agree to a credit report and criminal background check?

If answered yes to any of these questions, please explain.

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