Nominee Profile Form 2015-2017
BOARD OF DIRECTORS 2015 – 2017 NOMINATION FORM NOMINATIONS CLOSE MARCH 20, 2015 Name of Candidate: _____________________ This information will be posted as a part of your candidate profile in the members only section of the CCGI website. Please also submit your full Curriculum Vitae and an electronic photograph to be posted with your profile. Please complete this form: PART 1: Nominee Statement Please answer the following questions in 250 words or less. How does serving on the Caribbean Corporate Governance Institute fit with your values and commitment to creating better companies and efficient markets through Corporate Governance? 250 words or less What do you think is the greatest challenge facing the Caribbean Corporate Governance Institute as it works to advance its mission? 250 words or less DIRECTORS: Dennis Brown, Leslie Clarke, Clarence Faukner, Desiree Gobin-Seecharan (CEO, Corporate Secretary) Dr. Axel Kravatzky (Chairman), Fe Lopez- Collymore, Arnold Niranjan, Marlon Yarde REGISTERED OFFICE: 14 Alcazar Street, Port of Spain, Trinidad & Tobago Tel: +1 868 221 8707, Fax: +1 868 221 5306 [email protected] PART 2: Board Competencies The competencies required by the Caribbean Corporate Governance Board include combinations and variations of the following: • Experience on Corporate Boards • Financial Management • Entrepreneurial Leadership • Fundraising • International Trends in Corporate Governance • Financial Markets • Caribbean Corporate Law • Accountancy and Audit • Strategic Planning • Caribbean countries (focus is on the 20 Countries that form part of CARICOM) • State Owned Enterprises • Closely Held Companies (including Family Business) • Listed and Regulated Companies • Corporate Governance Education • Corporate Governance Codes and Guidelines • Sector specific Corporate Governance Please note your areas of strength related to these competencies: 150 words or less Please note any relevant professional designations or qualifications: 150 words or less DIRECTORS: Dennis Brown, Leslie Clarke, Clarence Faukner, Desiree Gobin-Seecharan (CEO, Corporate Secretary) Dr. Axel Kravatzky (Chairman), Fe Lopez- Collymore, Arnold Niranjan, Marlon Yarde REGISTERED OFFICE: 14 Alcazar Street, Port of Spain, Trinidad & Tobago Tel: +1 868 221 8707, Fax: +1 868 221 5306 [email protected] PART 3: Board, Work, Leadership and Life Experience Board Experience - Please list your present or prior board experience: Name of Organization From (date) To (date) Position(s) on Board Work and Leadership Experience - Please list your relevant work and leadership experience. Please also attach your Curriculum Vitae as a Word or PDF file. Name of Organization From (date) To (date) Accomplishments Life Experience – CCGI is committed to equity, diversity and inclusiveness. Please provide any information on your background and life experience that you think may be of assistance to members as they consider issues of diversity and inclusiveness in electing a new Board. Life Experience: 150 words or less Country Experience – CCGI is committed to serving members in the following countries. In which countries have you have work experience in? Anguila Belize Dominica Jamaica Antigua and Barbuda The Bahamas Barbados Bermuda Grenada Montserrat British Virgin Islands Cayman Islands Guyana Saint Kitts and Nevis Saint Lucia Haiti Saint Vincent and the Grenadines Suriname Trinidad and Tobago Turks & Caicos Islands DIRECTORS: Dennis Brown, Leslie Clarke, Clarence Faukner, Desiree Gobin-Seecharan (CEO, Corporate Secretary) Dr. Axel Kravatzky (Chairman), Fe Lopez- Collymore, Arnold Niranjan, Marlon Yarde REGISTERED OFFICE: 14 Alcazar Street, Port of Spain, Trinidad & Tobago Tel: +1 868 221 8707, Fax: +1 868 221 5306 [email protected] PART 4: Nominee’s Consent and Declaration I hereby declare the information submitted in support of this nomination is accurate and true. I consent to my nomination to the Board of Directors and consent to the Caribbean Corporate Governance Institute conducting the necessary background checks and that any omission to the process would disqualify my nomination. I consent to the posting of the information provided above, my photograph and Curriculum Vitae on the CCGI website members only section for the purposes of this election. I have read all attached material, and understand the commitment required to fulfill the position and agree to abide by the CCGI’s Bye-laws, the Board’s Governance Policies and Election Protocol. I affirm that I am: a member in good standing with CCGI compliant with CCGI’s code of conduct. currently a senior executive or director of an enterprise prepared to dedicate at least 2 days per month to CCGI activities throughout my term. This will include Board meetings, special meetings, committee meetings, and other events that may come up from time to time prepared to be an ambassador for good governance practice in the Caribbean willing to represent CCGI’s position before government officials and to members of the media, if called upon to do so willing to provide company/industry input and would contribute to written positions being put forward from CCGI as required prepared to invest in my governance education through self-funded participation in at least one international conference or the CCGI’s director education programme during my term of office. Name of Nominee: ________________________ Nominee’s Signature: ______________________ Date: ____________________________________ Please send a photo that can be posted on CCGI Members’ only section of the Website. The Nominee Profile may be submitted separately from the Nominations Form; Please ensure that both the Nominee Profile and the Nominations Form are submitted before the deadline. Please complete and return the forms no later than March 20, 2015 by email to: Email: [email protected] For more information on Elections Protocol, please contact us at [email protected] DIRECTORS: Dennis Brown, Leslie Clarke, Clarence Faukner, Desiree Gobin-Seecharan (CEO, Corporate Secretary) Dr. Axel Kravatzky (Chairman), Fe Lopez- Collymore, Arnold Niranjan, Marlon Yarde REGISTERED OFFICE: 14 Alcazar Street, Port of Spain, Trinidad & Tobago Tel: +1 868 221 8707, Fax: +1 868 221 5306 [email protected]
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