Please note:

•We may reach out to you for additional information regarding your application. Upon acceptance of your application, we may ask for your bio and digital photo for website posting.

•PAC membership is by invitation only and volunteer based. There is no monetary compensation and travel expenses are reimbursed only for preapproved travel required by PSCFL.

•The PAC member does not have authority to act for, represent, or bind PSCFL and cannot take action that implies they have this type of authority.

•The PAC member must not share any confidential information with any party.

•The PAC member does not own any PSCFL content, trademark, or assets at any time.

•The PAC member is responsible for ensuring that PAC duties listed herein do not conflict with any arrangement with another organization or venture. Any potential conflict of interest that arises must be disclosed.

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* 1. Name

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* 2. Phone

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* 3. Email

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* 4. Address

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* 5. Current or Last Employer

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* 6. Occupation

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* 7. Florida Certified Recovery Peer Specialist

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* 8. Please briefly describe why you would like to be a PAC member:

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* 9. How can PSCFL benefit from your PAC membership?
I have skills and experiences with:

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* 10. I have personal and/or professional expertise regarding these populations:

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* 11. Please list other board or advisory council membership:

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* 12. Please insert your professional summary which may be edited and posted on our website as your bio if you are selected to serve on the PAC.

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* 13. Have you ever been found guilty of fraud or ethics violations?

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* 14. Please upload a current resume for review. 

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Attestation:

I hereby attest that the following statements are true:

a) If elected, I agree to abide by and perform all PAC duties listed herein.

b) I have no financial interests that would present a conflict of interest in service on the PAC. If such conflict should arise, I agree to excuse myself from any such discussion, resign from the PAC, and leave if requested by the PAC.

c) I agree to uphold the mission, purpose, and public presence of PSCFL and to support the organization and never take any action that may harm PSCFL.

d) I agree to help with the growth and sustainability of the organization.

e) I have no open criminal cases and have never been investigated for ethics violations.

f) I will not disclose any confidential information that I may obtain as part of my PAC duties, to anyone.

g) I fully understand the role, requirements, and the information in this application. I hereby apply for the PAC role. I understand that my application may be rejected, and my membership can be revoked at any time without cause.

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* 15. Signature

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* 16. Date

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