Application Form for MRCKC Vice-Chair Position

The above MRCKC Executive Committee position is open for nomination. If you are interested in

being a candidate for this position, please fill out the following form and return it to Nola Bienhoff.

• via email: NolaBienhoff@gmail.com;

• U.S. mail: 600 Broadway St, Suite 200, Kansas City, MO 64105;

• or fax: (816) 421-7758.

Please also submit an updated resume with your nomination form.

A nominating committee will review all nominations and will compile the final ballot. The vote will

take place at an MRCKC Full Corps meeting.

Name: ________________________________________________________________

Address:_______________________________________________________________

_____________________________________________________________________

Email: ________________________________________________________________

Phone #s: _____________________________________________________________

Occupation/Background:

_____________________________________________________________________

Have you completed the MRCKC required trainings (Orientation, IS 22, IS 100, and IS 700)?

Yes No

If not, are you willing to complete the required trainings in the next three months?

Yes No

Please list the Emergency Preparedness Trainings you have completed:

Please give reasons for seeking this position (i.e., what experience/skills you bring to the position,

why you are interested in the position)

Please list other organizations you volunteer for and in what capacity:

Please read the following statement, sign and date it to indicate your agreement.

I, ________________________________________, have read the position description for

the MRCKC Executive Committee Officer role for which I am applying. I understand the expectations

of the position and if elected intend to meet those expectations to the best of my ability.

_____________________________________________________________________

Signature Date

Please remember to submit an updated resume with this nomination form.

Thank you!