Fillable CITIZEN-LEADERSHIP-FORM CITIZEN LEADERSHIP FORM

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CITIZEN-LEADERSHIP-FORM CITIZEN LEADERSHIP FORM

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CITIZEN LEADERSHIP FORM
(Application to Serve on Authority, Board or Commission)
TOWNSHIP OF FLORENCE
Date:
Mayor & Members of Township Council
Township of Florence
711 Broad Street
Florence, New Jersey 08518
ATTN: Joy M. Weiler, Township Clerk
Dear Mayor and Township Council:
I, , residing at hereby apply
(name) (city, state, zip code)
to perform public service on the following municipal authority(s), board(s) or commission(s):
1.
2.
3.
I have listed any education, prior volunteer experience, work-related experience and/or other civic
involvement, which could be of use to the authority(s), board(s) or commission(s) listed above.
Should you need to contact me, my telephone number is and
my email address . Thank you for your attention and consideration to
this matter.
(I understand my personal information (phone number and address) is considered confidential and same is
restricted from public disclosure under the Open Public Records Act.)
Sincerely,
Signature
Please provide a brief explanation, list and/or attach any education, prior volunteer experience, work-
related experience and/or other civic involvement, which could be of use to the authority(s), board(s)
or commission(s) listed above.
ALSO: I understand that I will be subject to the New Jersey Local Government Ethics Law and,
depending on the Authority, Board or Commission, I understand that I may have to file a brief
Financial Disclosure Statement each year, as mandated by the State of NJ.
______________________________
Signature & Date
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CITIZEN-LEADERSHIP-FORM CITIZEN LEADERSHIP FORM

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Completed 12 July 2020

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