Fillable APPLICATION FOR APPOINTMENT TO COMMITTEES, BOARDS AND COMMISSIONS (County of Otsego)

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APPLICATION FOR APPOINTMENT TO COMMITTEES, BOARDS AND COMMISSIONS (County of Otsego)

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The APPLICATION FOR APPOINTMENT TO COMMITTEES, BOARDS AND COMMISSIONS (County of Otsego) form is 3 pages long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for County of Otsego

BROWSE COUNTY OF OTSEGO (MI) FORMS

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APPLICATION FOR APPOINTMENT TO
COMMITTEES, BOARDS AND COMMISSIONS
The information provided on this form is for the use of the Otsego County
Board of Commissioners in its deliberation to fill vacancies on committees,
boards and commissions. Applications may be submitted at any time and
will be kept on file for a period of one (1) year. Applicants may be asked to
attend a designated meeting of the County Board of Commissioners for
application review and appointment consideration.
To which committee(s), board(s) or commission(s) are you seeking appointment?
Please print or type.
Name:
Address:
Zip Code
Telephone:
Other:
Date available for appointment
County Commission District
Are you a registered voter in Otsego County?
Yes ____ No
If yes, which township, city or village?
Please complete the following. You may use additional sheets as needed.
Community Service
List boards, commissions, committees or community service organizations that you are
currently serving or have served upon, offices held and in what municipality or county.
_______________________________________________________________________________________
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Employment and Education
List any employment experience or education that, in your opinion, best qualifies you for
this appointment. List job titles, duties (current and past), level of education and any
certificates or degrees you have obtained.
_______________________________________________________________________________________
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Have you ever worked for Otsego County? ____ Yes ____ No
If yes, please list dates and name(s) of departments.
_______________________________________________________________________________________
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Personal
Rules of law and ethics prohibit appointees from participating in and voting on matters in
which they may have a direct or indirect financial interest. Are you aware of any
potential conflicts of interest? ____ Yes ____ No
If yes, please indicate potential conflicts.
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Are you aware of the time commitment necessary to serve on the committee, board
and/or commission to which you seek appointment and will you have such time?
____ Yes ____ No
Please provide information about specific training, education, experience or interests you
possess that qualify you as an appointee to the position you seek.
_______________________________________________________________________________________
_______________________________________________________________________________________
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I hereby certify that the preceding information is correct and to the best of my
knowledge.
Signature
_____________________________
Date
Mail or return your completed application to: Otsego County
Attn: County Administration
225 West Main Street, Room 203
County/City Building
Gaylord, MI 49735
Thank you very much for giving us the opportunity to consider you for appointment.
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APPLICATION FOR APPOINTMENT TO COMMITTEES, BOARDS AND COMMISSIONS (County of Otsego)

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Completed 22 January 2021

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