Lake County, Ohio
APPLICATION FOR BOARD/COMMISSION MEMBERSHIP
Name:
Address:
Phone Number:
E-Mail Address: ________________________________________________________
I am interested in serving on the following Board/Commission: ____________________
Check appropriate box: New Appointment Reappointment Temp. Appointment
Why are you interested in serving on this Board/Commission?
What are your qualifications to serve on this Board/Commission?
Please list your current and past involvement with other Boards, Commissions or Taskforces
The following individuals are qualified to comment on my capabilities:
Name Address Phone Number
Resume Attached: Yes No
Please return completed application and resume (if you wish) to:
Lake County Board of Commissioners
Board Application/Attn: Clerk
105 Main Street, 4
th
Floor
Painesville, Ohio 44077
Jennifer.bell@lakecountyohio.gov
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