Town of Essex
Application to serve on a Board or Commission
Name:
Address:
Home Phone:
Cell Phone:
Email:
Board or Commission you are interested in:
How long have you been an Essex resident?
Are you a registered voter in Essex?
Political Party Affiliation:
Republican
Democrat
Other
Education:
Occupation:
Employer:
Municipal/Civic Experience:
Why are you interested in serving on this Board/Commission?
Please provide any additional information that you think would be helpful in processing your
application.
Signature:
Date: