PLACEMENT SELECTION FORM 2016-2017 Last Name: _________________________ First Name: _____________________ Address: __________________________________________________________ Email Address: _____________________________________________________ Phone: ___________________ Year You Became an Active Member: __________ MY PLACEMENT(S) FOR 2015-2016 WERE/ARE: _________________________________________________________________ _________________________________________________________________ MY CHOICES FOR COUNCIL & COMMITTEE PLACEMENT 2016-2017 ARE (please indicate if you would like to join a specific committee and/or chair a committee): 1. _____________________________________________________ 2. _____________________________________________________ 3. _____________________________________________________ How many hours are you able to give to JLIR each month? ___________________ Would you be willing to do a double-placement? YES NO Would you be willing to chair a committee? YES NO Are you able to make/receive JLIR-related phone calls during work? YES NO Are you able to receive JLIR-related emails through your work email or check personal email during work hours? YES NO COMMENTS OR CONCERNS (circumstances which may affect your placement): _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Send completed form to Elizabeth Swann, Immediate Past President and Nominating & Placements Chair, at [email protected]. SIGNATURE: _______________________________________ DATE: _________________
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PLACEMENT SELECTION FORM 2016-2017 Last Name: _________________________ First Name: _____________________ Address: __________________________________________________________ Email Address: _____________________________________________________ Phone: ___________________ Year You Became an Active Member: __________ MY PLACEMENT(S) FOR 2015-2016 WERE/ARE: _________________________________________________________________ _________________________________________________________________ MY CHOICES FOR COUNCIL & COMMITTEE PLACEMENT 2016-2017 ARE (please indicate if you would like to join a specific committee and/or chair a committee):
1. _____________________________________________________ 2. _____________________________________________________ 3. _____________________________________________________
How many hours are you able to give to JLIR each month? ___________________ Would you be willing to do a double-placement? YES NO Would you be willing to chair a committee? YES NO Are you able to make/receive JLIR-related phone calls during work? YES NO Are you able to receive JLIR-related emails through your work email or check personal email during work hours? YES NO COMMENTS OR CONCERNS (circumstances which may affect your placement): _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________
Send completed form to Elizabeth Swann, Immediate Past President and
Nominating & Placements Chair, at [email protected]. SIGNATURE: _______________________________________ DATE: _________________
initiator:[email protected];wfState:distributed;wfType:email;workflowId:f241e2c798c445bcb26764bf51e6c205
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