Board Member Nomination and Application

Date (required)

Contact Information

Applicant Full Name (required)

Email Address (required)

Home Address (Enter your home address, city, state and zip.) (required)

Work Address (Enter full work address, city, state and zip.) (required)

Cell Phone (required)

Work Phone

Preferred Address: Would applicant prefer home or work address used as mailing address?

Work

Home

None

Do you prefer to have your personal contact information remain private? (required)

Yes

Board Application

Name of Board you are applying for (required)

Nominated by (if applicable)

Unique qualifications and/or perspectives you would bring to a Board or Commission: (required)

Are you a current member of another board(s). If yes, please list board names.

Have you ever been a member of another board(s)? If yes, list board and dates.

Additional Information

Are you or any of your family members a White City Metro Township employee?

Yes

Have you ever been convicted of a felony? Answer yes or no. If yes, please explain. (required)

Submit your Resume here as an attachment. You may submit your resume as a PDF, Doc, Docx, or Text document.

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