Fillable CITY OF STAYTON APPLICATION FOR COMMISSION/COMMITTEE (City of Stayton)

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CITY OF STAYTON APPLICATION FOR COMMISSION/COMMITTEE (City of Stayton)

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The CITY OF STAYTON APPLICATION FOR COMMISSION/COMMITTEE (City of Stayton) form is 2 pages long and contains:

  • 1 signature
  • 5 check-boxes
  • 19 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Stayton

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PLEASE COMPLETE BOTH SIDES OF THIS APPLICATION
CITY OF STAYTON
APPLICATION FOR COMMISSION/COMMITTEE
N
AME OF COMMISSION/COMMITTEE: PLEASE CHECK ONE:
New Applicant
Application for reappointment
Years resided in Stayton:
PLEASE PRINT
Name
Address Home Ph#
Email Address Cell Ph#
Occupation
Place of Employment
Business Address
Phone Email
1. P
lease 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. W
hy do you want to become a member of the above-mentioned commission/committee and what
specific contribution would you hope to make?
PLEASE COMPLETE BOTH SIDES OF THIS APPLICATION
3. Please list the community concerns related to this commission/committee that you would like to see
addressed if you are appointed.
4. B
riefly describe your present or past involvement in relevant community groups. (Having no
previous involvement will not disqualify you for appointment.)
5. A
re you currently serving on any Advisory Boards, Commissions or Committees? If so, which ones?
6. How did you learn about this vacancy?
Our Website Word of mouth Other
7. 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?
Signature of Applicant Date
P
LEASE RETURN TO
: City of Stayton
362 N. Third Avenue
Stayton, OR 97383
It is the policy of the City to comply with all federal and state statutes on equal employment opportunity. This policy
shall be applied without regard to any individual employee or job applicant’s 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.
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CITY OF STAYTON APPLICATION FOR COMMISSIONCOMMITTEE (City of Stayton)

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Completed 5 August 2020

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