Boards and Commission Application

COS Logo

Application for positions on City Boards, Commissions and Committees

NOTE: Some positions may require the filing of a disclosure of economic interest.

Title:

First Name: ■

Last Name: ■

Home Mailing Address:

Street Name City, State Zip

Phone (day):

Phone (evening):

E-Mail Address: ■

Vocation/Profession:

Education/Qualifications/Job Experience(s):

Interests/Community Service Activities:

Boards/Commissions on which you wish to serve:

Please make selection in order of preference

1st Choice:

2nd Choice:

3rd Choice:

I hereby certify that the above information is correct to the best of my knowledge.

Date: ■

in lieu of signature

/ /

Thank you for your interest in serving on a City Board, Commission or Committee. Your information will be kept on file until such time a vacancy occurs. The Nominations Committee will then consider your application and make its recommendation to City Council. Should you have questions, please call the Clerk of Council at 332-3810.

The City of Staunton, Virginia does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services.

Sections

Boards and Commission Application

Application for positions on City Boards, Commissions and Committees

Personal tools