Board and Commission On-Line Application

Please complete all required fields. Required fields are marked with *.

Default

General Information

Board/Commission and seat you are seeking:

Preferred Seat

Additional Board 1

Boards on which you have served

Title

First Name

Middle Name

Last Name

Home/Message Phone

Business Phone

Cell Phone

Mailing Address

City

State

Zip

Email Address

Are you a registered voter?

NoYes

Have you ever been convicted of a misdemeanor or a felony?

NoYes

Conviction Details

Conflict of Interest

Are you willing to provide a full disclosure of personal financial data if required for the board or commission which you are applying?

NoYes

Is it possible that you or any member of your family will benefit financially by decisions to be made by the board or commission for which you are applying?

NoYes

Please explain the potential financial benefit

Training, Experience & Qualifications

List any professional licenses, certifications, or registrations and dates obtained that may be used as qualifying criteria:

List both formal and informal education and training experiences:

List any community service, municipal government, and state positions held, and any awards received.

Employment work history including paid, unpaid or voluntary.

Equal Employment Opportunity

Date of Birth

Gender

Military Service

Ethnicity

Certification of Accuracy & Completeness

Type "I certify"

Resume Addendum

Attach Resume

Generate a new image Play the audio code

Enter the code from the image