Application Form for Nomination to Board of Directors

Prior to completing the application below, please visit mazuma.org/election for important information, including:

  • Your role as a Board director
  • Responsibilities of a Board director
  • Minimum requirements
  • The nomination process
  • Key dates and events

The application below must be completed in its entirety and postmarked or emailed by February 2, 2018. You may return it by mail or email:

1. Mail

Board of Directors Application

7260 W. 135th St

Overland Park, KS 66223

2. Email

Subject: Board of Directors Application

There following 2 items are needed to submit a successful application:

  1. Application – included below
  2. Resume or list of applicable occupational, educational or volunteer experience. (Please provide this as an additional page with the application.)

Thank you for your interest in becoming a member of the Mazuma Board of Directors.

Application for Nomination to Board of Directors

Name ______

Address ______City ______State ____ Zip ______

Work Phone ______Home Phone ______

Last 4 Digits of Mazuma Member # ______

You may attach additional sheets as needed.

What are your thoughts on the credit union movement and the value credit unions bring to Members?

Why are you seeking election to Mazuma Credit Union’s Board of Directors?

If elected, what will you contribute to the Board of Directors and Mazuma Credit Union?

Please write a 200 maximum word essay on why you would make an ideal member of the Mazuma Board of Directors. (This essay will be used on the voting site.)

Will you commit two or three evenings per month to credit union activities? This includes but is not limited to personal attendance at monthly business meetings, budget and strategic planning meetings and the annual meeting. Yes ___. No ___.

Have you ever held a position of trust at a financial institution? Yes ___. No ___. If so, please list the position(s), institution(s) and the date(s):

Your Background

Have you ever been a director or officer of a financial institution whose charter has been revoked?
Yes ___. No ___.

Have you ever been denied an individual or fidelity bond, or had a bond canceled or revoked?
Yes ___. No ___.

Have you ever been convicted of any criminal offense involving dishonesty or breach of trust?
Yes ___. No ___.

If you answered “Yes” to any of the questions above, please explain the circumstances below:

References

Please provide 2 references:

Reference 1

Name ______Relationship ______Phone ______

Reference 2

Name ______Relationship ______Phone ______

I certify, as required in this application, that I have read and understand all application instructions and that all the information and statements I have provided in this application are current, correct, and complete to the best of my knowledge. I hereby authorize Mazuma Credit Union to obtain any information necessary for completing a background check or credit check. I understand that withholding information requested on this application, or giving false information, may be grounds for denial of candidacy to the Mazuma Board of Directors or may be grounds for impeachment from the Board after I have been elected.

Signature ______Date ______