APP FOR VOLUNTEERS FOR CITY BOARDS / COMMISSIONS / AND COMMITTEES

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Application for Volunteers for City
Boards / Commissions / and Committees

Personal Information

Name

First Last

Address

Street Address City State ZIP Code

Phone

Email

Position(s) Applying for:

Are you a registered voter?

Yes

No

When would you be able to start?

MM slash DD slash YYYY

Do you currently serve on any City Boards, Commissions or Committees?

Yes

No

If yes, list them:

Have you ever been employed with the City of Kirby?

Yes

No

If yes, date(s):

Are you or your spouse related to any elected official or employee of the City of Kirby?

Yes

No

EDUCATION AND TRAINING:

Name of Schools Attended and Location

Approx. Dates Attended

Major Field

Degree Received

SKILLS:

The following space is provided for other information concerning special training, interests, or any other data you wish to provide.

CONVICTIONS:

Have you ever been convicted of a Felony or other crime?

Yes

No

If yes, date:

MM slash DD slash YYYY

If yes, please explain (You may omit convictions for minor traffic violations):

REFERENCES: (If Desired)

List three persons not related to you who are qualified to describe your capabilities for the position you seek.

Name

Address

Phone

Occupation

I certify that the statements and information contained herein are true, complete, and correct to the best of my knowledge, I understand that the information will be used only for the purpose of evaluating my application for volunteer service. A photocopy of this authorization shall be as valid as the original.

Signature of Applicant:

Date

MM slash DD slash YYYY

Δ