Other Background Information Relevant to Serving in this Position:
I am qualified and interested in serving on this Board because:
Have you ever been convicted of a felony or misdemeanor by any court or do you have any pending
criminal charges against you?
□
Yes
□
No If yes, please Explain:
WAIVER REQUEST (If Applicable):
I am requesting that the following rule(s) be waived in order to serve on the Commission:
Residency Requirement (Bisbee Resident for less than 1 year)
Length of Service (I have served
terms)
Number of Commission Memberships currently served. I also serve on the:
I am requesting this/these waivers for the following reasons for consideration:
I hereby certify and affirm that all the information contained in this application is true, complete and correct. I understand that
false or misleading statements or the omission of important information made on this application or any time during the process
may disqualify me from volunteer work with the City of Bisbee. I understand that the Mayor and Members of the Council must
approve any waiver request.
Signature:
Date:
When complete, please return to:
City Clerk Office P.O. Box 4601, Bisbee, AZ 85603 E-mail: acoronado@bisbeeaz.gov
nwilliams@bisbeeaz.gov
