Association of Surgical Technologists>

I, , do hereby consent to serve the Association of Surgical Technologists, Inc., (AST) in the capacity of:












I understand that by consenting to serve AST in this position I am making a commitment to perform a variety of activities and further agree to carry out all tasks appropriate to the office including, but not limited to, the following.

I will:

  1. Make every effort to familiarize myself with the AST Bylaws and the AST Policy Manual.
  2. Maintain an adequate filing system pertaining to all aspects of my position beginning immediately following conference.
  3. Maintain an open line of communication with national headquarters. Communication is essential to the harmony and effectiveness of AST business.
  4. Be aware of report deadlines as directed in the AST Policy Manual.
    • These reports are due twice yearly, prior to the mid-year Board meeting and the national conference.
    • I keep a copy for my files.
    • All reports/correspondence must be sent to national for distribution.
  5. Give thoughtful consideration to my efforts when assigned by the President to work on any assignment or special project and will perform those tasks to the best of my ability.
  6. Fully understand that holding an AST elective position requires a considerable amount of verbal and written communication skills and entails a substantial work effort.
  7. I further agree to resign from the Board of Directors in the event of seeking employment with AST, ARC/STSA, or NBSTSA.
  8. I further agree that if at any time I am unable to serve in this capacity or if I fail in my responsibilities to the Board of Directors, House of Delegates, and membership, I will offer my resignation and notify the AST Board of Directors in sufficient time so that a replacement may be acquired to ensure that committee activities are not unduly interrupted.

Dated this 22 day of November, 2017

This consent-to-serve form will be discarded two years from date of receipt. If after that time you remain interested in working with AST, you must submit a new consent-to-serve form and curriculum vitae.

CURRICULUM VITAE CANDIDATES

AST Requests All Information Be Completed In Full

Employment

 
 
 

AST Involvement

Additional documents are optional

Election Statement

Please submit an election statement on why you want to serve AST. The AST Credentials Committee will be notified of your application. Your statement will published for the membership in the March edition of The Surgical Technologist. It will also be used in AST conference materials posted on AST’s website and in our conference app in the weeks leading up to conference in June.



Eligibility to Run for Elected Office

All candidates running for elected office in the national organization must without exception be certified with currency (by the National Board of Surgical Technology and Surgical Assisting (NBSTSA) as a CST or CSFA and have been an active member of AST for a minimum of at least two years (24 complete months).

In addition to providing AST and the national Credentials Committee with signed copies of the consent to Serve from and Curriculum Vitae, those individuals seeking elected office must also provide detailed information that will establish your eligibility to run for national office.

  1. Name: {{name}}
  2. I attest that I have been a Certified Surgical Technologist (CST) or Certified First Assistant (CFA) since (year) and my certification number is {{certnum}}.
  3. I attest that I have been a member of AST with continuous, uninterrupted membership since (minimum of three full years) and my membership number is .
  4. I attest that I qualify to run for President, Vice President, Secretary, Treasurer, or for the Board of Directors.

    Those individuals seeking an officer position must comply with the following requirements:

    AST Bylaws:
    Article VII. Officers
    Section 2. Eligibility of Officers
    A. A candidate shall have been an active member for three years immediately preceding nomination and, if elected shall maintain that active status.
    B. A candidate shall have served at least one full term during the previous six years on the Board of Directors.

    I previously served on the national Board of Directors for one full term (two years) from to (month, day, year). Your most recent term on the Board will suffice for eligibility purposes.

    Those individuals seeking a director position must comply with the following requirements:

    Article IX. Board of Directors
    Section 2. Eligibility of Directors
    A. A candidate for the Board of Directors shall have been an active member for three years immediately preceding nomination and, if elected shall maintain that active status.
    B. A candidate for the Board of Directors shall have served at least one complete term on a national committee, whether standing or special (ad hoc), the NBSTSA, the ARC/STSA or a complete two-year term as a director in a state assembly within the last eight years.

    For the purposes of determining eligibility to run for the Board of Directors, candidates must have served at least one complete two year term in one of these capacities as defined in bylaws. One full term on an (1) AST national committee equals two years; (2) NBSTSA Board of Directors, equals two years; (3) ARC/STSA Board of Directors equals two years; or a complete two-year term as a director in a state assembly within the last eight years. Portions of various terms may not be counted cumulatively (i.e., one year here, six months there, etc.).

    I previously served at least one full term as defined in at least one of the capacities outlined above (specify) from (month, day, year) to (month, day, year). Your most recent position will suffice for eligibility purposes but if in doubt specify other qualifying positions and dates.

Terms and Conditions

I have agreed to submit this application by electronic means. By signing this application electronically, I certify under penalty of perjury and false swearing that my answers are correct and complete to the best of my knowledge.

I also certify that:

  • I understand the questions and statements on this application.
  • I have read and understand the legal information.
  • I understand the penalties for giving false information or breaking the rules.
  • I understand that AST may contact other persons or organizations to obtain needed proof of my eligibility.

I understand that the deadline to submit the Consent to Serve and Curriculum Vitae is January 15.

If I meet the eligibility requirements for the position I’m seeking, as determined by the Credentials Committee:

  1. I understand that my candidate information and election statement will be published in the March issue of the AST Journal and subsequent conference publications, the AST website, or social media;
  2. When I check into the annual conference I will receive a "Candidate" ribbon for my badge; and
  3. I will be able to have candidate literature on a table in the AST registration area at the conference.

I further understand that if I submit my Consent to Serve and Curriculum Vitae at any time after the January 15 deadline, it means that I must be nominated from the floor of the AST House of Delegates at the conference, and will not be considered a candidate until that is done in the first business session, further meaning:

  1. I understand that my candidate information and election statement will not be published in advance of the AST conference;
  2. I will not receive a “Candidate” ribbon until after the first business session;
  3. I will not be able to distribute candidate literature in the AST registration area until after the first business session; and
  4. I must physically appear before the Credential Committee at the Candidates/Delegates Counter in the AST registration area on the day before the conference begins with signed copies of my Consent to Serve and Curriculum Vitae in order to "clear credentials." The Candidate/Delegate Counter hours are posted in the Conference Guide, Delegate/Alternate Handbook.

I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.

*By checking this box and typing my name below, I am electronically signing my application and agree to the above terms and conditions.

Please type your First and Last Name