Board/Committees Application

Please fill out the form as best as you can. If you have no answer, please write "Not Applicable".

Name:
Date:
Home Address:
Location of Residence:
Business Location (if applicable):
Cell Phone:
Home Phone:
Email:
Work Phone:

Check below the Committees or Boards you are willing to serve on:
Economic Development Advisory Committee
Library Board
Planning and Zoning Board
Parks and Recreation Advisory Board
Police Pension Board
Tree and Beautification Advisory Committee

Occupation:


Training or experience related to activities of boards and committees to which appointment is sought:


Member of the following professional or business organizations:


Have you served on a Town board or committee in the past?Yes  No

If yes, name of committees/boards and dates:


Nationality (optional)


Have you ever been convicted of a felony? (optional) Yes  No

List three references that the Town may contact (excluding Town employees) - name, address and phone number:

Add any additional information or comments here:

I will attend meetings in accordance with the adopted policies of the Town. If at any time my business or professional interests conflict with interests of the board or committee, I will not participate in such deliberations of the board or committee.

Please note: You may be required to fill out a financial disclosure form.

By submitting this form I certify the information I provided is true and accurate to the best of my knowledge.