Association of Surgical Technologists

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

Bylaws, Resolutions, and Parliamentary Procedures Committee
Education and Professional Standards Committee
State Assembly Leadership Committee
Accreditation Review Committee for Education in Surgical Technology and Surgical Assisting
Ad Hoc Committee/Task Force/Advisory Committee
Subcommittee on Accreditation for Surgical Assisting (SASA)
National Board of Surgical Technology and Surgical Assisting

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:

Make every effort to familiarize myself with the AST Bylaws and the AST Policy Manual.
Maintain an adequate filing system pertaining to all aspects of my position beginning immediately following conference.
Maintain an open line of communication with national headquarters. Communication is essential to the harmony and effectiveness of AST business.
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.
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.
Fully understand that holding an AST elective position requires a considerable amount of verbal and written communication skills and entails a substantial work effort.
I further agree to resign from the Board of Directors in the event of seeking employment with AST, ARC/STSA, or NBSTSA.
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 3 day of December, 2024

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 APPOINTED

AST Requests All Information Be Completed In Full

First Name

Last Name

Date

Address

Cert. Number

City

State

Zip

Phone

Employment

Facility Name

Phone

Address

City

State

Zip

Number of Years Employed:

BRIEF DESCRIPTION OF DUTIES:

AST Involvement

NUMBER OF YEARS IN AST:

PAST POSITIONS HELD WITHIN AST:

BRIEF DESCRIPTION OF YOUR ROLE IN THESE POSITIONS:

Other Organizational Involvement

Hospital/Work Committees

What was the committee's function?

What was your role on this committee?

Number of years on this committee

Community/Volunteer Involvement

What was the committee's function?

What was your role on this committee?

Number of years on this committee:

How do you see your role in the leadership of AST?

Do you have specific skills such as computer skills, writing, which will help you in your leadership duties?

How would you resolve a conflict with another person?

Please list references here:

Additional documents are optional 2MB max per file. ( PDF Formats Only )

Current Resume (optional)

Diplomas (optional)

Certificates (optional)

Outstanding Achievements (optional)

Accepted File formats PDF only. Please no file larger than 2MB each.

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

Step 1. Check the box below
*By checking this box and typing my name below, I am electronically signing my application.

Step 2. Type in your name

Please type your First and Last Name

Association of Surgical Technologists>

CONSENT TO SERVE