2. 
4. VYC Advisor Application
6. First Name*
7. Last Name*
9. Name you would like to go by:
10. Email Address*
12. Address*
14. City
15. State
16. Zip Code
18. Phone Number*
19. Work Number
21. Years Lived in Vineyard*
25. EDUCATIONAL BACKGROUND
27. Name of high school or preparatory institution with city and state and major courses of study
28. Name of college(s) with city and state, major courses of study, academic year completed or date of graduation, and diploma or degree(s)
30. Additional education (if any)
32. List any other licenses, certificates, publications, or professional achievements that would support this application.
33. Please list additional skills or technical or professional knowledge that would enhance this application.
37. EMPLOYMENT HISTORY
39. List names of employers with city and state, position, and dates of employment.*
43. PERSONAL STATEMENTS AND QUESTIONNAIRE
45. Why do you want to become a VYC Advisor?
46. Can you attend monthly meetings?
48. What do you consider is the strongest attribute you could offer as a VYC Advisor?
50. Describe your vision for VYC in the next 2 years.
52. What is the biggest obstacle you will have in serving on VYC?
56. Certificate of Applicant*

    I understand that any omission or misrepresentation of information may cause my application to be rejected or, if I am hired, may cause me to be terminated. I authorize any employer accepting this application and any person, organization, former employer, or other entity listed in this application to ask or answer any and all questions about me and I agree not to sue and to hold harmless any person or entity that provides information or expresses an opinion about me or my performance. I understand that this document is an application for employment and not an offer to employ me. I understand that if I am employed, my employer may terminate me at any time without reason or explanation. If hired, I agree to protect the confidentiality of any confidential information I obtain as a consequence of my employment. If hired, I agree that the value of any advance payment, property issued me, or other debt I owe my employer shall be due upon termination of my employment and may be deducted from wages or other payments owed me at the time of such termination.

    1. I certify that all information on this form is true and correct to the best of my knowledge.
58. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
60. Electronic Signature
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62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit Submit and Print

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