Fillable Application for Appointment to Citizen Advisory Board or (City of Van)

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Application for Appointment to Citizen Advisory Board or (City of Van)

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The Application for Appointment to Citizen Advisory Board or (City of Van) form is 3 pages long and contains:

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Country of origin: US
File type: PDF

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Application for Appointment to Citizen
Advisory Board or Commission
Please return this completed application to: City of Van, 189 South Maple Street Van, TX 75790.
Board or Commission Desired:
(Note: Please apply for only one board or commission per applicant)
Personal Data
Last Name First Name Middle Name
Number & Street City State Zip
Home Phone Work Phone Cell Phone
E-mail Address Van Zandt Co. Voter Registration Number
Education & Training
Highest Grade Completed College?
Yes
No
Graduated?
Yes
No
Graduation Date
Degree Earned Name of School Hours Earned
Major(s) Minor(s)
Please Note: Only text that is visible in the text box will show when printed.
Special knowledge or skills: Please list any special knowledge or skills which qualifies you for
this appointment.
Interest: Explain why you are interested in being appointed for this board.
Experience: Indicate what meeting(s) you have attended of the committee for which you wish
to be considered.
Indicate the number of Van City Council Meetings you have attended in the past 12 months.
References
List the name and phone number of at least one Van resident as a reference, especially any City
staff, City Council, or Current Committee members who may be contacted on your behalf.
First Name Last Name
Occupation Years Known Phone
First Name Last Name
Occupation Years Known Phone
First Name Last Name
Occupation Years Known Phone
Current Employment
Employer:
Address City: State:
Job Title Phone
Please read the statement below and sign your name to indicate your understanding.
I UNDERSTAND MY ATTENDANCE WILL BE REQUIRED AT ALL COMMITTEE MEETINGS.
_____________________________________________
Signature of Applicant
____________________________
Date Signed
Please return this completed application to: City of Van, 189 South Maple Street Van, TX 75790.
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Application for Appointment to Citizen Advisory Board or (City of Van)

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Completed 24 January 2021

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