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