Fillable CANDIDATE APPLICATION FORM (City of Winchester)

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CANDIDATE APPLICATION FORM (City of Winchester)

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CANDIDATE APPLICATION FORM
for City Council-Appointed Boards & Commissions
Representatives of City Council will conduct interviews of applicants interested in serving on a City Board or Commission.
Board Preferences: 1. _________________________________________ 2. __________________________________________
Name: ___________________________________________________ Preferred Phone: ________________________________
Home Address: ____________________________________________________________________________________________
Preferred Email: ___________________________________________________________________________________________
Profession: ___________________________________________________ Winchester resident for _________ years
Business Name: _________________________________________ Business Telephone:________________________________
Business Address: __________________________________________________________________________________________
I have read and will adhere to the City’s Code of Ethics, Professional Conduct Policy, and will attend the next available board
member orientation provided by the City. is information can be found online at www.winchesterva.gov/government/boards-
and-commissions.
I consent to a background check should I be selected by Council for appointment.
Why do you wish to serve the City of Winchester?
What experience, skills or education do you have relative to the position(s) for which you are applying?
What are your major interests or concerns regarding the City government?
Return the completed application using one of the below methods:
1) Mail/Drop o - Rouss City Hall, 15 N. Cameron Street, Winchester, VA 22601 (City Manager’s Oce)
2) Email - kerri.mellott@winchesterva.gov
3) Fax - (540) 722-3409, Attn: Clerk of Council
Applications will remain on le for three years. e City of Winchester volunteer positions are open to all
persons without regard to race, sex, age, handicap, religion, ethnic background, or national origin.
What other interests or concerns do you have regarding the community?
Have you ever pleaded guilty or been convicted of a crimal oense? If so, please list.
Yes No Explain: ______________________________________________________________________________
______________________________________________________________________________
Have you ever been involved in a matter that could negatively impact the public’s perception regarding a decision by Council to
appoint you to a board or commission? If so, please explain.
Have you or any member of your immediate family ever been employed by the City or Winchester Public School System?
Yes No
Are you aware of any issues which could cause a conict of interest if you are selected to serve on the board or commission to
which you have applied? If so, please explain.
Please list any previous or present involvement in public service that you may have had such as service as a member of City
Council, board or commission member, citizen committee, etc. in Winchester or elsewhere.
Signature: _________________________________________________________________ Date: _________________________
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CANDIDATE APPLICATION FORM (City of Winchester)

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Completed 17 July 2020

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