Fillable Application for Board/Committee Town of Douglas 29 Depot (Town of Douglas)

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Application for Board/Committee Town of Douglas 29 Depot (Town of Douglas)

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The Application for Board/Committee Town of Douglas 29 Depot (Town of Douglas) form is 2 pages long and contains:

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  • 14 check-boxes
  • 23 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Douglas

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For office use only
Appointed:
Residency confirmation by Town Clerk:
Town of Douglas
29 Depot Street
Douglas, MA 01516
508-476-4000 ~ Fax: 508-476-4012
Application for
Board/Committee
Please submit this application to the Selectmen's Office.
Name:
Residence:
Date:
Email:
Post Office Box:
Phone (Home):
Enter Numbers only, no
dashes.
Phone (Work):
Enter Numbers only, no
dashes.
Yes No
Date
Resigned:
Date
Did Not Seek Re-appointment
Employee Name:
Employee Address: Occupation / Title:
Education:
1a. For the Planning Board, and Zoning Board :
Full Member Alternate / Assoiate Member
2. Would you be interested in another Board / Committee? Please select:
1. Please select the Board / Committee are you applying for:
3. How long have you lived in Douglas?
4. In order to verify your address, you must be a registered voter. Are you registered in Douglas?
Yes
No
5. Have you been asked by this Board / Committee to become a member?
Yes
No
6. How did you hear about this
Board / Committee?
7. Why are you seeking this
appointment?
The Town of Douglas is an equal opportunity provider, and employer.
Term
Print Form
The filling out of this form in no way assures appointment. All board/committee vacancies
will be filled by citizens deemed most qualified to serve in a particular capacity.
Please return this form to the Selectmen's Office.
The Town of Douglas is an equal opportunity provider, and employer.
8. What is your experience or
knowledge regarding the duties of
this Board / Committee?
9. Please list any education,
experience, proffesional
achievement, previous occupation,
skills, or special interests you may
have that will assist you with this
Board / Committee.
10. How many times during the last year have you attended a meeting of this Board / Committee?
10 a. Watched a video of this Board / Committee?
11. Would there be a possible conflict of interest if you were appointed to this Board / Comittee?
Yes No
If yes, please explain:
12. Have you ever had business before this Board / Committee?
Yes No
If yes, please explain:
2. What other Board / Committee have you served on? Please select:
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Application for BoardCommittee Town of Douglas 29 Depot (Town of Douglas)

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Completed 22 January 2021

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