Volunteer Candidate Application Amplify Credit Union | P.O. Box 85300 | Austin, Texas 78708Amplify Federal Credit Union

Volunteer Candidate Application

Name:__________________Phone:(Work)______________(Home/Cell)______________E-Mail:___________________ Address:_____________________________________________________________________________________________ City:__________________State: ______________ Zip: _____________

Position Desired: __________________________________________________________

Current Position with Credit Union (If Applicable): Please list all other volunteer positions you have held with the credit union with dates served.Dates Positions _____________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ _________________________________________________________________________________

Reason for Wishing to Serve Amplify Federal Credit Union: (Please use the back of this form if necessary.)

Educational Background:

SCHOOL COURSE OF STUDY DEGREE OBTAINED

Professional and/or Financial Services Industry Experience: Include Professional and Volunteer Activities & Attach Resume

NAME/TYPE OF BUSINESS

POSITIONS HELD DATES OF WORK OR SERVICE

FROM TO

How knowledgeable are you in understanding financial reports and other documents related to the operation of a financial institution? (Please explain.)

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Professional and/or Financial Services Industry Experience: Include Professional and Volunteer Activities and Attach Resume:

Volunteer Application

Are there any other experiences, skills, training or qualifications which you think would be of benefit to you in serving as a volunteer? (Please list them below.)

What is your perception of how much time you would have to devote to credit union activities as a volunteer?

References: Please list three references who could provide information regarding your professional and/or voluntary activities in the last 10 years.

NAME & OCCUPATION

ADDRESS DAYTIME PHONE NUMBER

We have as ked you a s eries of ques tions to p rovide a more comple te unders tand ing of your qua lifica tions as a cand ida te fo r s e rvice as a vo lun teer. Are there a reas tha t you would like to d is cus s tha t you be lieve would re flec t favorab ly on your cand idacy?

A date will be s e t fo r your in te rview with the Nominating Committee . Dates and times fo r in te rviews will be announced a t a la te r da te .

VOLUNTEER DISCLOSURE

NOTE: A positive response to any or all of the questions below is not an automatic bar to Volunteer. All circumstanceswill be considered. These questions are not limited by timeframe - please fully disclose any and all applicable situationsregardless of when they occurred.

1. Have you ever been fired or asked to resign from a job? Yes No2. Have you ever been convicted of, or pled guilty or nolo contendre (no contest), in a domestic or foreign court, to any

felony or misdemeanor (excluding minor traffic violations)? Yes No3. Are you presently the subject of any criminal action investigation or proceeding or have you ever entered into a Nolle

Prosequi (no prosecution) diversionary or deferred adjudication/deferred prosecution program? Yes No4. Has any organization over which you exercised management or policy control ever been convicted of any

misdemeanor or felony act during or as the result of your volunteer service? Yes No5. Have you ever had any securities or insurance license suspended or revoked? Yes No6. Have you ever had any Bond coverage modified or revoked, or has any application for a Bond ever been declined?

Yes No

1. Haveyoueverbeenfiredoraskedtoresignfromajob? .................................................................... Yes No

2. Have you ever been convicted of, or pled guilty or nolo contendre (no contest), in a domestic orforeigncourt,toanyfelonyormisdemeanor(excludingminortrafficviolations)? .............................. Yes No

3. Are you presently the subject of any criminal action investigation or proceeding or have you ever entered into a Nolle Prosequi (no prosecution) diversionary or deferred adjudication/deferred prosecution program? .......................................................................................................................... Yes No

4. Has any organization over which you exercised management or policy control ever been convicted of any misdemeanor or felony act during or as the result of your volunteer service? ........ Yes No

5. Have you ever had any securities or insurance license suspended or revoked? ............................... Yes No

6. HaveyoueverhadanyBondcoveragemodifiedorrevoked,or has any application for a Bond ever been declined? ...................................................................... Yes No

We have asked you a series of questions to provide a more complete understanding of your qualifications as a candidate for service as a volunteer. Are there areas that you would like to discuss that you believe would reflect favorably on your candidacy?

A date will be set for your interview with the Nominating Committee. Dates and times for interviews will be announced at a later date.

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IMPORTANT: If you have answered "YES" to any question, please provide the FULL details below, including dates,locations, charges, etc. If you answered "YES" to multiple questions, please identify each of your responses below withthe number of the question to which it refers. Provide Full Details:

FAIR CREDIT REPORTING ACT

DISCLOSUREAs a volunteer candidate applicant with this credit union, you have rights under the Fair Credit Reporting Act (FCRA). By this document, this credit union discloses to you that a consumer report may be obtained for volunteer application purposes as part of the volunteer application background investigation and at any time during your term, if you are appointed and/or elected . If this credit union obtains a consumer report about you, and if this credit union considers any information in the consumer report when making a volunteer application related decision that directly and adversely affects you, this credit union will provide you with a copy of the consumer report and a summary of your rights under the FCRA before the decision is finalized. You also may contact the Federal Trade Commission about your rights under the FCRA.

AUTHORIZATIONBy submitting this application, I acknowledge that I have received the foregoing disclosure that this credit union may obtain a consumer report as part of its background investigation and/or during the course of my service, if I am appointed and/or elected. By submitting this application, I voluntarily authorize this credit union to obtain consumer reports about me and to consider the consumer report in its background investigation and/or when making decisions during the course of my service onthe Board (and/or Nominating Committee or Supervisory Committee), if I am appointed and/or elected. I understand that I have rights under the Fair Credit Reporting Act, including the rights discussed above.

ACKNOWLEDGMENTS

APPLICANT ACKNOWLEDGEMENT All qualified applicants will receive consideration without regard to sex, race, color, national origin, genetic information or ancestry, age or disability. No information on this application will be used for the purpose of discrimination.

APPLICANT ACKNOWLEDGEMENT – PLEASE READ CAREFULLY I certify that all of the information provided by me in this application (or any other accompanying or required documentation) is true, accurate, and complete. I understand that the falsification, misrepresentation or omission of any facts in these documents will be cause for denial of application or immediate suspension and/or removed from the Board (and/or Supervisory or Nominating Committee) as provided in the credit union’s by-laws regardless of the timing or circumstances of discovery.

I voluntarily grant this CREDIT UNION the right to investigate and verify the information and statements I have provided in this application and agree to hold all persons harmless with respect to any information they may give, receive or verify.. Information is obtained through personal interviews with my references and/or credit agencies or bureaus, including a background check.This investigation may include information as to my character, general reputation, personal and professional history, and

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financial and credit record.

I certify that I am a member in good standing with the Amplify Federal Credit Union, and that if elected (or appointed to Nominating Committee or Supervisory Committee), I will attend all scheduled (monthly) Credit Union Board meetings REQUIRED (or Nominating Committee or Supervisory Committee meetings as scheduled) and carry out the responsibilities of my office to the best of my ability.

If appointed or elected, you will abide by the following:Certain provisions of NCUA final rule 701.4, General Authorities and Duties of Federal Credit Union Directors, in that, thepurpose of this rule is to clarify and document the important fiduciary duties of Boards of Directors of federal credit unions. You are advised of your responsibility and obligation to Amplify Federal Credit Union with regard to confidential structure, and member and financial information AS PROVIDED IN THE BY-LAWS, POLICIES AND GUIDELINES. You understand you are not to disclose any confidential and/or member information, including, but not limited to, employee or member lists and associated financial status, outside the structure of the committee or Board to which you take office. You understand that you are not to disclose any of the facility or operational details of the Amplify Federal Credit Union that are not normally available to the general membership. You understand if a director fails to attend regular meetings of the Board for three (3) consecutive months, or otherwise fail to perform any of the duties devolved upon him/her as a Director, his/her office may be declared vacant by the Board and the vacancy filled as provided by the credit union’s By-laws. You understand and agree that if you are appointed/elected to the Board (and/or Nominating Committee or Supervisory Committee) you will abide by all the rules, regulations, policies and procedures of the credit union at all times. You understand and agree to complete Amplify Federal Credit Union’s Conflict of Interest Disclosure and Statement and to abide by the credit union’s policies: 6.2 Business Ethic andConduct, and 6.6 Conflicts of Interest. Please acknowledge by signing below:

__________________________________ _____________________________ Signature Date

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