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Standing Advisory Group Nominee Form

(This form to be used only to nominate yourself to serve on the SAG. For the form to nominate another individual to serve on the SAG, go here.)



Personal Information
First Name  
Middle Name  
Last Name  
E-mail  
Daytime Phone  
Alternate Phone  
Fax  
Country
Mailing Address
  
City  
State  
Zip  
     
Qualifications
Current Occupation
Title
Current or Most Recent Employer
Type of Entity
Employer Web Site
Dates with Current or Most Recent Employer
(Month, Year)
From:  , 
To: , 
Job Function and Responsibilities
Highest Education Degree Awarded
College/University
College/University Country
College/University State
College/University Graduation Year
Professional License or Certification
State or Organization
Date 
Current


Professional Associations or Affiliations
Past Officer
Current Officer
Current Member
Current Board Memberships
(including Audit Committees)
Member
Chair

What is your expertise? (check all that apply)
 Accounting
 Auditing
 Corporate Finance
 Corporate Governance
 Investing in Public Companies
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:
Have you previously served on the Standing Advisory Group?
If you answered yes to the previous question, please specify during which term(s) you served:
Have you previously submitted a nomination form to serve on the Standing Advisory Group?
If you answered yes to the previous question, please specify in which year(s) you submitted a nomination form:
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:
If applicable, describe your relationship to any matter that, to your knowledge or belief, is the subject of a pending law enforcement or regulatory investigation:
If applicable, describe the circumstances of any request directed to you for documents, testimony, or information in connection with any law enforcement or regulatory investigation in the last five years.
Please include your current curriculum vitae by browsing to the file using the control below (Files larger than 1MB will not be sent):

The PCAOB may conduct searches of public records concerning applications to serve on the Standing Advisory Group.