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Application for EACC Commissioner

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Application for EACC Commissioner

Please complete and submit this online application to be considered for appointment to the Employee Assistance Certification Commission. Current EACC members will thoroughly review each application submitted and contact candidates to schedule a time for a telephone interview. New Commissioner's terms begin October 2, 2014, immediately following EAPA's Annual World EAP Conference. Applications must be received by May 5, 2014.

Yes
No

Type of EAP experience and number of years (if none in any category, enter NONE):

EAPA leadership positions (past and present)(if none in any category, state NONE):

Please provide two (2) professional references (indicate contact information and the number of years you’ve known each individual in the space provided below):

Demographic data (Optional) To help ensure a diverse representation on the Commission:

25-34
35-44
45-54
55 and over
M
F

Thank you for your interest in becoming an EACC Commissioner. Should you need any further information, please contact Director of Credentialing, Shirley Springfloat: 703.387.1000, ext. 311, or via e-mail at certdir@eapassn.org.