New Memorial Local Board Information Packet w additional questions 2 by 43X4vjro

VIEWS: 0 PAGES: 6

									                                                                                FOR MORE INFORMATION CONTACT
                                                                                                   Human Resources
                                                                                                     P. O. Box 1575
                                                                                        Colorado Springs, CO 80901
                                                                                     cityrecruiting@springsgov.com
`
         New Memorial Health System – University of Colorado Health Local Board
                                                 Seeks Volunteers
The City of Colorado Springs is preparing for the upcoming historic partnership between the City and University of
Colorado Health (UCH) for the lease of the operations of Memorial Health System to UCH. Assuming the partnership
will be finalized as expected on October 1, 2012, the “New Memorial - UCH System” entity (“New Memorial - UCH”) will
assume the operations of the current Memorial Health System and will be overseen by a “New MHS - UCH Local
Board”. Under the City partnership with UCH, the City has the opportunity to select and nominate 7 of the 11 positions
on the New MHS - UCH Local Board. Therefore, the City is now accepting applications for the New Memorial - UCH
Local Board.

The New Memorial - UCH Local Board (“the Board”) will work directly with the Executive Team of New Memorial - UCH,
and with the UCH System Parent Board, to formulate policies and financial benchmarks for New Memorial - UCH, and
provide critical and timely decision making on key issues. The Board is directly involved in the supervision and
evaluation of the New Memorial - UCH Chief Executive Officer and has a close relationship with the UCH System Parent
Board.

Citizens interested in serving on this Board should possess one or more of the following:
      Strong financial background.
      Knowledge of healthcare management.
      Involvement and understanding of community issues.
      Experience in the management of large organizations, preferable in a board role.
      Familiarity with non-profit organizations and their unique issues and concerns.

Useful skills include:
     Knowledge of personnel policies.
     Knowledge of how to manage personnel in healthcare organizations.
     Strong written and verbal communication skills.
     Comfort with public communication.
     Experience with financial statements, revenue and cash flow management, and audits.
     Experience and success as a working member on the board of a large organization.

The knowledge, skills, and abilities we are seeking for the New Memorial - UCH Local Board are not limited to the
above, and other skills and experience will be considered.

These are volunteer positions, and will require a minimum commitment of 10 hours per month (most likely more hours
during the Board’s first year).

Please complete the Application for Appointment to the New MHS - UCH Local Board, which can be found at
www.SpringsGov.com by clicking on “Get Involved” then click on “Commissions and Committees”. Either email your
application to cityrecruiting@springsgov.com or mail it to the physical address above no later than September 27,
2012.

For questions or more information, please call Michael Sullivan, Human Resources Director at (719) 385-5117.
This page intentionally left blank.
                                               APPLICATION FOR APPOINTMENT TO
             New Memorial Health System – University of Colorado Health Local Board

The City seeks to have diversity in making appointments to boards, commissions and committees. It is the policy of the City to make appointments to
the citizen boards, commissions, and committees, based on the needs of the City as well as the interests and qualifications of each applicant without
discrimination based on race, color, national origin or ancestry, gender, religious convictions, disability, age, or sexual orientation.

                    Please return this application to cityrecruiting@springsgov.com or
   Human Resources, Attn: Violet Heath, P.O. Box 1575 (Mail Code 720), Colorado Springs, CO 80901-1575


Please Print Clearly. Information May Also be Typed.
Last Name:                                                                   First Name:                                                  M.I.:
Home Phone Number:                                                Cell:                                    Email:
Home Address:
City:                                                                        State:                       Zip:
Business Address:
City:                                                State:                                               Zip:
Length of Residency in El Paso County:
Nominated By:                                        Email Address:                                       Phone:


EDUCATIONAL BACKGROUND:




PROFESSIONAL LICENSES AND/OR ASSOCIATIONS:




EMPLOYMENT EXPERIENCE:




VOLUNTEER/BOARD EXPERIENCE:
APPLICATION FOR APPOINTMENT
TO A CITY BOARD, COMMITTEE OR COMMISSION




HOW WILL YOUR QUALIFICATIONS BEST SERVE THE NEW MHS - UCH LOCAL BOARD?




WHY DO YOU WANT TO SERVE ON THE BOARD?




TELL US ABOUT YOUR LEADERSHIP STYLE.




TELL US ABOUT YOUR PAST POSITIONS YOU THINK ARE RELEVANT/IMPORTANT TO THIS POSITION.




References
Please list three references.

Full Name                                                             Relationship

Company                                                               Phone (          )

Address

Full Name                                                             Relationship

Company                                                               Phone (          )

Address

Full Name                                                             Relationship

Company                                                               Phone (          )

Address


Please attach your resume.

My answers on this application are complete and true. I authorize the City of Colorado Springs and its agents to verify any information
related to my application. I also authorize and direct individuals, schools, employers, and law enforcement or government officials to
freely provide any information concerning my background, and hereby release any and all of them from any liability for doing so.



_____________________________________                  ______________________________
APPLICATION FOR APPOINTMENT
TO A CITY BOARD, COMMITTEE OR COMMISSION



Signature                                  Date
                                                                                                                     ATTACHMENT

        CITY OF COLORADO SPRINGS (“CITY”) BOARD, COMMITTEE AND COMMISSION SURVEY
                             VOLUNTARY SELF-IDENTIFICATION

Completion of this form is VOLUNTARY and in no way affects the decision regarding your appointment to a Board, Committee or
Commission. This form is confidential and will be maintained separately from your application.

Please Print
Last Name:                                                        First Name:                                                 M.I.:

Name of Board, Committee or Commission: New MHS - UCH Local Board                                               Date:

                    Indicate your choice of responses for items A-D by placing an “x” in the appropriate box.

               I elect not to identify


   A.    Racial Origin/Ethnicity:

         Check only one:

               White                                              Hispanic or Latino
               A person having origins in any of the original     A person of Mexican, Puerto Rican, Cuban, South or Central
               peoples of Europe, the Middle East or North        America or other Spanish culture or origin, regardless of race.
               Africa.
             Black or African American                            Native Hawaiian or Other Pacific Islander
             A person having origins in any of the Black racial   A person having origins in any of the original peoples of Hawaii,
             groups of Africa.                                    Guam, Samoa or other Pacific Islands.
          W American Indian or Alaska Native                      Asian
             A person having origins in any of the original       A person having origins in any of the original peoples of the Far
             peoples of North and South America (including        East, Southeast Asia or the Indian subcontinent including, for
             Central America), and who maintains tribal           example, Cambodia, China, India, Japan, Korea, Malaysia,
             affiliation or community attachment.                 Pakistan, the Philippine Islands, and Vietnam.

   B.    Gender:

               Female                                             Male

   C.    Age Group:

               18 to 39                                           40 and over


   D.    How did you learn of this position?

               Channel 18                                         Gazette

               City of Colorado Springs Internet Site             Professional Journal

               City of Colorado Springs Employee                  Local Area Newspaper

               Citizens’ Academy                                  Other (Specify):
                                                                                                                                09/12

								
To top