S:\FORMS\Volunteers\Commission & Committee Application form.rtf
c:\wpwin\admin\comm.app
City of Veneta * 88184 8th Street * PO Box 458 * Veneta OR 97487 * (541) 935-2191 * www.venetaoregon.gov
NAME OF COMMISSION/COMMITTEE: PLEASE CHECK ONE:
____ New applicant
_______________________________________ ____ Application for reappointment
Are you registered to vote in the State of Oregon? Yes No
Do you live within Veneta City limits? Yes No
How did you learn about this vacancy?
_____Newspaper _____Word of mouth _____Other
PLEASE PRINT
Name ______________________________________________________________________
(Last) (First)
Address ________________________________________ Home Ph# __________________
Email Address ___________________________________ Cell Ph# ____________________
Occupation __________________________________________________________________
Place of Employment __________________________________________________________
Business Address _____________________________________________________________
Phone _________________ Email _______________________________________________
Signature of Applicant ___________________________________ Date_____________
PLEASE RETURN TO: City of Veneta
P. O. Box 458
88184 8
th
Street
Veneta, OR 97487
It is the policy of the City to comply with all federal and state statutes on equal employment and volunteer
opportunities. This policy shall be applied without regard to any individual employee/volunteer or job
applicants sex, race, color, religion, national origin, ancestry, age, marital status, political affiliation, genetic
information, veteran status or any other legally protected status per state and federal law.
Application for Council or
Commission/Committee
S:\FORMS\Volunteers\Commission & Committee Application form.rtf
c:\wpwin\admin\comm.app
PLEASE COMPLETE BOTH SIDES OF THIS APPLICATION
Name ___________________________ Committee Applying for _____________________ Date __________
1. Please give a brief description of the experience or training that qualifies you for
membership on this commission/committee. (If you wish, you may attach a resume or
other pertinent material.)
2. Why do you want to become a member of the above-mentioned commission/committee
and what specific contribution would you hope to make?
3. Please list the community concerns related to this commission/committee that you would
like to see addressed if you are appointed.
4. Briefly describe your present or past involvement in relevant community groups.
(Having no previous involvement will not disqualify you for appointment.)
5. Are you currently serving on any Advisory Boards, Commissions or Committees? If so,
which ones?
6. Are you employed by, have any business, contractual arrangements or family
connections with programs having contractual agreements with the City that might be
within the purview of the committee on which you are seeking appointment?