Standing Advisory Group Nominee Form

The Board convened a Standing Advisory Group (SAG) to provide input and advice to the PCAOB on the development of auditing and related professional practice standards to enhance investor protection.

This form should be used only to nominate yourself to serve on the SAG. Use the Nominator form, listed in the right-hand column, to nominate another individual to serve on the SAG.

Personal Information
Salutation  
First Name*
Middle Name  
Last Name*
E-Mail*
Daytime Phone* ext.
 
Alternate Phone
 
Fax
 
Country*
Mailing Address*
City*
State (required for US residence only)*
Zip (required for US residence only)*
 
Birth Month and Date (to be used internally to create a unique nominee identifier)*
 
Qualifications
Current Occupation*
Title*
Current or Most Recent Employer*
Type of Entity*
Employer Web Site  
Dates with Current or Most Recent Employer*
From:
To:
Job Function and Responsibilities*
Highest Education Degree Awarded*
College/University*
College/University Country*
College/University State (required for US education only)*
College/University Graduation Year*
Professional License or CertificationState or OrganizationDateCurrent
Professional Associations or AffiliationsPast OfficerCurrent OfficerCurrent Member
Current Board Memberships (including Audit Committees)MemberChair
What is your expertise? (check all that apply)*
 











Other expertise relevant to the development of auditing or related professional practice standards: 
Please describe the unique attributes, expertise or experience that you will offer the PCAOB:*
Please describe any work and other initiatives you have participated in to enhance investor protection, including the result of that work or those initiatives: 
Have you previously served on the Standing Advisory Group?*

Have you previously submitted a nomination form to serve on the Standing Advisory Group?*

Have you ever been prohibited from practicing before the U.S. Securities & Exchange Commission or any other regulatory body?*

If you answered yes to the previous question, please provide further information regarding the circumstances:*
Have you ever been barred as an officer or director of any company?*

If you answered yes to the previous question, please provide further information regarding the circumstances:*
Have you ever been involved in any capacity (e.g., provided documents, testimony, or other information) in an investigation by a law enforcement or regulatory agency (including but not limited to DOJ, SEC, PCAOB, AICPA, FINRA, non-U.S. regulatory agency, U.S. state licensing board or any other licensing organization)?*

If you answered yes to the previous question, please provide further information regarding the circumstances:*
Please include your current curriculum vitae by browsing to the file using the control below (Files larger than 1MB will not be sent):
 
Consent to Public Records Search
I hereby consent to searches of public records concerning my application to serve on the Standing Advisory Group.
Sign Name*/s/
 
Date*
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* Required