UFA Co-operative Limited - UFA.com

UFA Co-operative Limited
2013 Delegate Nomination Form
Those interested in being nominated for the position of a UFA delegate are asked to self-assess
their qualifications, skills and experience. In the space provided below, please provide a
summary of your skills and experience in each category. This summary and your personal
Statement of Interest will be used for the purpose of developing a communication to members
regarding the candidates running for election and their respective qualifications.
Included with your nomination form you are required to provide a brief biography, an electronic
color photograph and a criminal record check. All requirements are to be submitted via mail to:
UFA Co-operative Limited
Attn: Tammy Mitchell
Suite 700, 4838 Richard Road SW
Calgary, AB T3E 6L1
or by e-mail to tammy.mitchell@ufa.com or by fax (403) 570-4021. If you require additional
information, please feel free to contact Tammy at (403) 570-4385.
Note that a criminal record check can take up to 3 weeks to receive.
Deadline for applications is June 28, 2013.
(Please print or write legibly)
Name
Address
City
Postal Code
Email Address Day Phone Home Phone Cell Phone
UFA Membership Number (s)
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A. Please answer yes or no to the following questions regarding minimum eligibility
requirements:
Are you 18 years of age or older? Yes No
Are you a resident in the district in which you are seeking Yes No
nomination?
Are you a member of UFA and eligible to vote? Yes No
Have you been a patron of the co-operative in the previous year? Yes No
Are you an employee, an agent of or hold any office of profit with
UFA? Yes No
Do you hold any material interest in any agent of UFA or in any
business in competition with UFA? Yes No
Are you a member of the Canadian House of Commons or any
Provincial Legislature? Yes No
Have you been convicted of any offence under the Criminal Code
of Canada for which no pardon has been issued? Yes No
How did you hear about the delegate election in your district?
Newspaper Past Delegate MR Rep Other _______________
B. Personal Statement of Interest
Why would you like to be elected or re-elected as a delegate?
How can you specifically contribute to UFA as a delegate who represents UFA
members?
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C. Business Background & Experience
Please indicate those areas below in which you have some knowledge or experience. Note: It
is NOT expected that all candidates will possess knowledge or experience in all areas. The
goal is for the delegate body as a whole to possess combined knowledge or experience in all of
the areas.
1. Petroleum/agribusiness, finance/accounting/banking, engineering/construction and/or retail.
2. Delegate or co-operative experience
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D. Personal attributes
Please describe your personal attributes that would enable you to be an effective delegate.
E. Describe any community involvement
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F. Biography
1. Please provide a short description of your involvement in agriculture.
2. Please provide a short description on why you would like to be a delegate.
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G. References:
Please provide two professional or personal references.
Name
Phone
Name
Phone
Before signing, be sure your application is filled out COMPLETELY and that you have read and
understand the following declaration:
By signing and submitting this application form, I acknowledge that:
1. All statements made in this application are true and accurate.
2. Any misstatements of material facts herein may cause forfeiture of my position as a
delegate with UFA.
Print Name
Date
Signature
Nomination forms will only be accepted if they include the following:
Nomination Form
Criminal Record Check
Insert Biography Requirements
Color Photo (if returning delegate not required)
Successful candidates will be contacted by the UFA Nominating Committee by August 19, 2013.
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