Fillable APPLICATION FOR BOARD APPOINTMENT (City Of Springfield, Ohio)

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APPLICATION FOR BOARD APPOINTMENT (City Of Springfield, Ohio)

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APPLICATION FOR BOARD APPOINTMENT
(PLEASE PRINT OR TYPE)
Name
Home Address, Zip Code
Occupation, Place of Employment
Home Phone Work/Cell Phone ___________________
E-Mail Address
Springfield Resident? ________ Number of Years in Springfield _________
Registered Clark County Voter? __________
Are you related to any City Official / Employee?
If so, State Name & Relationship
I am interested in appointment to the following board(s):
Have you served on any City Board(s) / Committee(s) previously? If so, please list with
approximate dates:
Please attach a brief summary of your formal education, work experience,
organizational memberships, area of interest or expertise, and community service.
Applicants Signature Date
APPLICATIONS MAY BE DELIVERED, MAILED, EMAILED OR FAXED TO:
Clerk of the City Commission
City of Springfield
76 East High Street
Springfield, Ohio 45502
jpierce@springfieldohio.gov * 937-324-7341 * FAX: 937-328-3497
THANK YOU FOR YOUR INTEREST IN THE CITY OF SPRINGFIELD!
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APPLICATION FOR BOARD APPOINTMENT (City Of Springfield, Ohio)

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Completed 24 January 2021

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