Fillable CANDIDATES REQUEST FOR APPOINTMENT ADVISORY BOARDS AND COMMITTEES (Town of Surf City)

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CANDIDATES REQUEST FOR APPOINTMENT ADVISORY BOARDS AND COMMITTEES (Town of Surf City)

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CANDIDATES REQUEST FOR APPOINTMENT
ADVISORY BOARDS AND COMMITTEES
TOWN OF SURF CITY
Are you a Town of Surf City resident, at least 18 years of age, willing to volunteer your time and expertise to
your community? Please complete this application and return to:
Board/Committee: _______________________________________
Applicant Name: _______________________________________
Home Address: _______________________________________ TEL:_______________________
Business Address: _______________________________________ TEL:_______________________
Do you live within the Corporate limits of Surf City? Yes No
How long have you been a resident in Surf City? _______ Years
Education and Employment Information
High School: ____________________________________________________________________
Year Graduated: ____________________________________________________________________
Institution Name: _____________________________________________________________________
Year Graduation: _____________________________________________________________________
Major: _____________________________________________________________________
Current Employer: _____________________________________________________________________
Title/Position: _____________________________________________________________________
Duties: _____________________________________________________________________
Mail Completed
Form: Town of Surf
City Attn: Town Clerk
PO Box 2475
Surf City, NC 28445
Email completed form:
shobbs@surfcityn
c.gov
Fax completed form:
910-328-4132
General Information
Current membership in organizations and offices held:
_______________________________________________________________________________________
_______________________________________________________________________________________
Past organizational membership and offices held:
_______________________________________________________________________________________
_______________________________________________________________________________________
Do you anticipate a conflict of interest by serving as a member of a Board or Committee? _______________
If yes, explain:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Do you possess subject matter education, training, and/or experience for the Board or Committee for which you
are applying? If yes, explain below
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
If no, state reasons why you feel qualified for this appointment.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
NOTE:
This information will be used by the Town Council in making appointments to Boards and Committees. In the
event you are appointed, some information may be used as a news release to identify you to the community.
_______________________________________
NAME
_______________________________________
DATE
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CANDIDATES REQUEST FOR APPOINTMENT ADVISORY BOARDS AND COMMITTEES (Town of Surf City)

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Completed 16 July 2020

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