City Board Application

Serving on City Board Application

Date

MM slash DD slash YYYY

Name

First Last

Signature

Phone

Email

Home Address

Street Address Address Line 2 City State ZIP Code

Occupation

How long have you been a resident of IRB?

Are you a registered voter?

Yes

No

Are you related to a commissioner or an employee of the City of IRB?

Yes

No

Please indicate the boards/committees that you are interested in serving on:

Board of Adjustments & Appeals

Finance & Budget Review Committee

Planning & Zoning Board

Would you consider serving on another board/committee other than the one(s) selected?

Yes

No

Have you ever held public office at any time?

Yes

No

If yes, please provide description & dates served:

Have you ever served on a city board/committee?

Yes

No

If yes, please provide boards/committees and dates served:

Do you currently serve on a city board/committee?

Yes

No

If yes, please provide boards/committees and when term will expire:

Provide a description of your Education & Training

Provide a description of your Experience/Brief Job History

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