Campbell County Board and Commission Interest Statement
Name: _________________________________________________________________
Address: _________________________________________________________________
Phone/Fax: _________________________________________________________________
Email: _________________________________________________________________
Board/Commission Areas of Interest:
______________________________________________________________________________
Highest Level of Education Achieved:
______________________________________________________________________________
Professional Certifications (if applicable):
______________________________________________________________________________
Please attach a current resume detailing your professional experiences,
community involvement and references
I acknowledge that I am expected to attend a minimum of 75% of the meetings held by the board
or commission to which an appointment may be made. Failure to do so, without specific medical
necessity, may result in forfeiture of appointment.
Signature: __________________________________________________________________
Date
Return form to: Campbell County Judge/Executive
1098 Monmouth Street, Suite 301
Newport, KY 41071
Or spendery@campbellcountyky.gov
Fax 859-292-3822
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