Application for City Boards,
Commissions & Committees
Name: _________________________________________________________________________________
(First) (Middle) (Last Name)
Address: _______________________________________________________________________________
(Street) (City) (State) (Zip)
Telephone: _________________ __________________ __________________ ___________________
(Home) (Work) (Cell) (Fax)
Email: ________________________________________________________________________________
Driver’s License: ________________________ Gender: □Male □Female
Qualified Voter: □Yes □No Current Resident: □Yes □No If yes, number of years: ______
Company: ____________________________________ Job Title: _______________________________
Business Address: _______________________________________________________________________
(Street) (City) (State) (Zip)
Send Correspondence To: □Home □Business □E-mail Current Board Member: □Yes □No
LIST LICENSES OR CERTIFICATIONS APPLICABLE TO BOARD: __________________________
____________________________________________________________________________________
(If needed attach additional sheets)
Have you served on a board/commission/committee in the past? ______Yes _______No
If yes, what board/commission/committee did you serve?
_______________________________________________________________________________________
Are you available to meet during the day? ______Yes _______No
Please mark the committees you are interested in serving: ____ Board of Adjustment ____Building Standards
Commission ____ Planning and Zoning Commission _____ Tax Reinvestment Zone Board, Zone No. 1
Signature of Applicant: _________________________________ Date __________________
Please return application to:
City of Borger
Attention: Deputy City Secretary
600 North Main Street ● P.O. Box 5250 ● Borger, Texas 79008 ● 806.273.0908
kharber@borgertx.gov
Appointed to: ____________________________________________ on________________________
Board/Commission/Committee Date
NOTE: Applications remain on file for one year or until the applicant receives an appointment. Incumbents whose
terms expire and who are eligible for reappointment will be contacted by the Deputy City Secretary concerning their
desire for reappointment.
ELIGIBILITY REQUIREMENTS: Borger residents must be eligible to vote in the City hold no publicly elected
office, and must not be delinquent in payment of any amounts due to the City, including property taxes, water
utility payments, adjudicated citations, etc. Information submitted is public information under the Texas Public
Information Act. Public deliberation and selection of applicants by City Council is subject to the provisions of the
Texas Open Meetings Act.
CONFLICT OF INTEREST: Applicants should acknowledge any potential conflict of interest, to include current or
past business contracts. Relatives or relations who do business with the City, or any potential condition that may be
construed as a conflict of interest.
