10a. If applicable, how long have you been engaged in farming or production, and what is the size of your farming operation. (i.e.
List acreage and pou
nds produced by kind of crop, as well as, kinds and numbers of livestock?)
11. List your
business experience. (Use the Continuation Sheet for additional space to answer.)
12. List education and any specialized experience. (Use the Continuation Sheet for additional space to
answer.)
13. List applicable farm/handler/producer/importer or co-op member industry
organizations (indicate whether a member or officer
and how long affiliated).
14. List other affiliations and/or service as a community leader that would
benefit you in your role as a member of the advisory
committee or research and promotion board/council.
15. List any Federal advisory committee or board
on which you are currently a member and the number of years you
have served
on that committee or board.
(To be completed by current Advisory Committee Members Only)
16. List sources of income in excess of
$10,000
for the past calendar year from other than your
primary employment. List only
sources; do not show amounts of income from each source.
(To be completed by Advisory Committee Nominees Only)
_________________________________ _____________________________________
_________________________________ _____________________________________
17. Have you
ever been convicted of a felony?
(A felony is defined as any violation
of law punishable
by imprisonment of longer
than one year).
(
) Yes
(
) No.
If yes, please explain on the attached continuation sheet.
18. As a resu lt of your participation in
Federal programs, have any judgments been rendered against you?
As a result of
participation in any
governmental programs relative to the purposes of the advisory committee or research and promotion
board/council for which you are a nominee, have any civil or criminal actions been initiated against you?
(
) Yes
(
) No.
If yes, please explain on the attached continuation sheet.
19
. Name as you would prefer it to
appear on official correspondence.
Signature
Date
