Fillable 1445 Application for Boards/Commission

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1445 Application for Boards/Commission

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File type: PDF

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Last Update: 05/25/2018
Application for Committees/Commission
Contact Information
Name:
Street Address:
Mailing Address:
City/State/Zip Code:
Home Phone:
Work Phone:
E-Mail Address:
Background
Years of Residence in Fairview:
Place of Employment:
Occupation:
Educational Background:
Prior Civic Activities:
Boards/Commissions of Interest
Please check all of the following Boards/Commissions that interest you:
If checking more than one, please prioritize your interest (1, 2, 3, etc.)
Budget Committee
Planning Commission
Community Engagement Committee (CEC)
Economic Development Advisory Committee (EDAC)
Parks and Recreation Advisory Committee (PRAC)
Public Safety Advisory Committee (PSAC)
East County Recreation Board
Last Update: 05/25/2018
Special Skills or Qualifications
Summarize any special training, skills or experience you may have pertinent to the Board/Commission
to which you are applying.
Motivation
Discuss your motivation for serving on this Board/Commission.
Special Notice
Please be advised that members of the City Council and Planning Commission are required to file an annual
Statement of Economic Interest with the State of Oregon. A sample reporting form is available from the
Administration Office at Fairview City Hall indicating the type of information you will be required to disclose if
you are appointed. Applicants may be subject to a background check pursuant to Chapter 2.45 of the Fairview
Municipal Code
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand
that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made
by me on this application may result in my immediate dismissal.
Name (printed)
Signature
Date
Applications expire December 31 of the calendar year in which submitted.
Our Policy
It is the policy of the City of Fairview to provide equal opportunities without regard to race, color,
religion, national origin, gender, sexual preference, age, or disability. The City of Fairview accepts
applications from potential board/commission members throughout the year and will hold applications
until vacancies exist on specific boards/commissions.
Thank you for completing this application form and for your interest in volunteering with us.
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1445 Application for BoardsCommission

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Completed 12 July 2020

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