PHYSICIAN ASSISTANT PROFESSIONAL ADVISORY GROUP
SELF-NOMINATION FORM: 2010
The Physician Assistant Professional Advisory Group (PAPAG) provides advice to the Surgeon General, through the Health Services Professional Advisory Committee (HS-PAC) and the Health Services Chief Professional Officer, on professional and personnel issues related to Department of Health and Human Services (HHS) and Commissioned Corps of the U.S. Public Health Service (Corps) Physician Assistants (PA). Selections are based on the nominee’s commitment to public health and PA activities in addition to specified criteria (e.g., organizational, discipline, gender, and minority representation). Selections are made by the PAPAG voting membership.
I am interested in serving on the PAPAG for a 3-year term beginning January 2010. If selected, I am expected to participate in all teleconference meetings, unless excused by the PAPAG Chair. I also agree to participate in PAPAG subcommittees and other PAPAG activities. I understand that each Corps active duty voting member shall meet and maintain Office of Force Readiness and Deployment (OFRD) force readiness standards (Corps officers only) and that membership in the PHS Academy of Physician Assistants (PHSAPA) is strongly encouraged, but not required.
Name:
Rank:
PHS Serial Number:
CAD (Call to Active Duty Date):
Duty Station Address:
Operating Division/Staff Division/non-HHS organization/program:
Institute/Center:
Mail Stop:
City:
State: Zip Code:
Duty Phone Number:
Fax:
Email Address:
Gender: M___ F___
Race or Ethnicity:
Primary Duty: Clinical___ Administrative___
OFRD Readiness: Yes___ No___
Active Duty Corps Officer: Yes___ No___
HHS Civil Service: Yes___ No___
Inactive Reservist: Yes___ No___
Retired PA: Yes___ No___
Are you a member of the PHS Academy of PAs? Yes___ No___
PAPAG Activities/Subcommittees of Interest to Me:
___Awards ___Recruitment ___Communication ___Readiness ___Mentor ___
Membership ___Career Development ___Anything that would be of help
I have included a copy of my current CV (including summary sheet) and a cover letter describing how my specific experience and expertise will benefit the PAPAG.
E-mail application, CV (including summary sheet) and cover letter to:
JEFF.BUCKSER@DHS.GOV
Nomination packages will not be considered unless all items are submitted. Notification of receipt will be sent.
NOMINATIONS MUST BE RECEIVED BY 30 May 2009.
Reference:
http://www.usphs-hso.org/pac/subcommittees/career_development/cv.shtml
for CV form
http://www.aapa.org/memship-cat.html
for PHS Academy of PA application and information
http://www.usphs-hso.org/pags/papag/papag_main.shtml
for PAPAG information and bylaws
For more information, contact:
CDR Jeff Buckser –
jeff.buckser@dhs.gov
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