Apply to Join our Board | Hanover & District Hospital Foundation

Board Member Application

Please fill out this form to apply for your new home.

First name

Last name

Email address

Phone number

Address

Number of years at this address

Preferred Contact Method

Eligibility Criteria & Conditions

I am at least 18 years of age;

I am not an undischarged bankrupt;

I am not a member of municipal council nor intend to run for council in the near future;

I will not profit from my role as a director and will avoid all situations which conflict with my interest

Have you ever been convicted of a criminal offence relating to financial dishonesty, tax evasion, theft, fraud or any other criminal offence relevant to operating a charity?

Yes (if yes, please provide details below)

No

Have you been convicted of a non- criminal offence within the past 5 years, relating to financial dishonesty or any other offence relevant to the operation of a charity?

Yes (if yes, please provide details below)

No

Have you been a Director, officer or manager of a charity during the period that charity engaged in serious non- compliant conduct that resulted in a revocation of charitable status, within the past 5 years?

Yes (if yes, please provide details below)

No

Have you ever been a promoter of a tax shelter that resulted in the revocation of a charity’s charitable status?

Yes (if yes, please provide details below)

No

If you answered YES to any of the above questions, please provide details.

Directors must avoid conflicts between their self-interest and their duty to the Foundation. In the space below, please identify any relationship with any organization or individual that may create a conflict of interest, or the appearance of a conflict

By submitting this application, I declare the following: I meet the eligibility criteria and accept the conditions of appointment set out above; I certify that the information in this application is true.

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Apply to Join our Board!

Board Member Application