APPOINTED OFFICIALS APPLICATION
Name: _______________________________________________________________________________
Address: _____________________________________________________________________________
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Phone Number: ______________________
Email Address: ________________________________________________________________________
Occupation: ___________________________________________________________________________
Years living at current residence: _____ Years as West Columbia resident: ____
Are you a current resident of West Columbia? _____________
Are you currently a registered voter? ____________________
Community Organization Involvement: _____________________________________________________
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Professional Experience: _________________________________________________________________
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Academic Background: __________________________________________________________________
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Additional Information: _________________________________________________________________
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I I understand that the City will require a South Carolina SLED background check. I acknowledge that
such investigations may be made, and that appointment is contingent upon the results of such checks.
Signature:
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Printed Name: _______________________________________ Date: __________________________