Fillable Greene County Application for Board Appointment (Greene County, MO)

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Greene County Application for Board Appointment (Greene County, MO)

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The Greene County Application for Board Appointment (Greene County, MO) form is 2 pages long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for Greene County, MO

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Greene County Application for Board Appointment
General Information
Name: __________________________________________________________
Home Address: ___________________________________________________
Cell Phone: ________________
Home Phone: ______________
Email Address: ___________________________________________________
How long have you lived in Greene County? ________Years/ _________Months
Do you live outside the Springfield city limits? Choose an item.
Employer: ______________________________________________________
Position: _______________________________________________________
Business Address: ________________________________________________
Business Phone: _____________________
Previous Employer and Position: ___________________________________
Previous Employer and Position: ___________________________________
Reference
Name: _____________________________
Relation: ___________________________
Phone Number: ______________________
Email: ________________________________________________________
Name: _____________________________
Relation: ___________________________
Phone Number: ______________________
Email: ________________________________________________________
Choose an item
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Educational Background:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Community activities:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Please remember to attach resume or curriculum vitae summary with your application.
In consideration of my appointment, I agree to conform to the policies, procedures, and
regulations of Greene County.
I, ___________________________, do hereby authorize Greene County to conduct an
investigation in respect to my application and release the county, my former employers, and
personal references from any liability for damage caused by giving and receiving information or
opinions as to my employment or character. Any information obtained through former
employers and/or personal references will become the property of Greene County.
I, __________________________, do hereby authorize the release of any information which
pertains to records of convictions for law violations, including felony, misdemeanor and traffic
violations, and agree to hold Greene County harmless and in no event shall the county be liable
to me for special, indirect or consequential damages for the refusal of appointment due to
information obtained during my police record check.
Board Selection
First Choice
Boards you are interested in serving:
Qualifications
Special qualifications (include past board service):
Second Choice Third Choice
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Greene County Application for Board Appointment (Greene County, MO)

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Completed 17 July 2020

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