Consent and Willingness to Serve Form
Boards, Commissions, and Committees
Name:_______________________________________________________________________
Residence Address:___________________________________________________________
Daytime Telephone:________________ Evening Telephone:_______________________
E-mail Address:________________________________________________________
Mailing Address:_______________________________________________________
Occupation:______________________Employer:_____________________________
Appointed position Desired (check all that apply):
__ Parks and Recreation Board __ Board of Ethics and Compliance
__ Library Board __ Planning Commission
__ Building Board of Adjustments & Appeals __ Senior Citizens Board
__ Cultural Diversity Awareness Commission Other____________________________
Briefly describe Your Interest & Qualifications for the Position Desired:
____________________________________________________________________________
____________________________________________________________________________
Please list any Civic or Community Endeavors in which you have been involved:
___
__________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Have you served on the Alvin City Council? Yes ____ No ____
Have you served on another City’s Council? Yes ____ No ____
Have you served on an Alvin City Board, Commission, or Committee? Yes ____ No ____
If so, list: ____________________________________________________________________
Have you served on another City’s Board, Commission, or Committee? Yes ____ No ____
If so, list: ____________________________________________________________________
How long have you been a resident of Alvin? _____________________Years
How long have you been a resident of Texas? _____________________Years
Voter registration No.
_______________________________
I understand that appointments are solely at the discretion of council and that this form is not the
only basis of candidate selection. If appointed, I will accept the position and faithfully serve to the
best of my ability.
Si
gned: _____________________________ Date: _________________________________
Please Return to the City Clerk’s Office. This form will be retained for one year.
216 W. Sealy St. Alvin, Texas 77511; Ph:281-388-4255; Fax: 281-388-4294; droberts@cityofalvin.com
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