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VILLAGE OF CALEDONIA VOLUNTEER APPOINTMENT APPLICATION (Village of Caledonia)

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Committee Appt. Form Rev 11/13/2018
Page 1 of 2
VILLAGE OF CALEDONIA
VOLUNTEER APPOINTMENT APPLICATION
The Village appreciates your interest in serving on one of
its Boards, Commissions, or Committees. Please complete the
for
m below and include a current resume. The form and resume
should be submitted to the Village Clerk’s Office at 5043 Chester Lane,
Racine, WI 53402 or email to ktorkilsen@caledonia-wi.gov
If you have any questions, please contact the Village Clerk at (262) 835-6415. Information on Boards,
Commissions, and Committees can be found at www.caledonia-wi.gov. When completing the form below,
please answer each of the questions and indicate the board(s), commission(s) and/or committee(s) that you are
interested in.
Name:
________________________________________________
Home Address: _________________________________________________________________________________
Email: ______________________________ Work No.: __________________________
Home No.: ___________________________ Cell No.: ___________________________
Please indicate which of the following you are interested in serving on, in order of preference (i.e., 1, 2, 3…):
Caledonia Plan Commission
Caledonia Utility District Commission
Caledonia Police and Fire Commission
Caledonia/Mt. Pleasant Joint Board of Health
Caledonia Development Authority
Caledonia Parks and Recreation Commission
Caledonia Sex Offender Residency Appeal Board
Board of Appeals
Board of Review
S
tate the reason(s) why you want to serve on this Board, Commission and/or Committee(s)?
Staff Use Only:
Date Rec’d: _________________________
Rec’d by: __________________________
Copy provided to: ___________________
Committee Appt. Form Rev 11/13/2018
Page 2 of 2
Are you familiar with the duties and responsibilities of this Board, Commission and/or Committee(s)?
Please describe them using your own words.
Have you
observed any meetings of this Board, Commission and/or Committee(s)?
If yes, when and what was the subject matter of the meeting(s)?
Do you hol
d an elective or appointed position or office? If so, what office(s) or position(s)?
Descri
be briefly your education and any work experience or other activity which in your opinion would be beneficial in
carrying out the responsibilities of this Board, Commission and/or Committee(s)?
If appoint
ed to this Board, Commission or Committee, are there any other activities in which you are engaged which
would interfere with your regular attendance or upon the duties required; if so, to what extent?
List other organizations of which you are a member.
Applicant Name: _______________________________________________ Date: __________________________
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VILLAGE OF CALEDONIA VOLUNTEER APPOINTMENT APPLICATION (Village of Caledonia)

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Completed 13 August 2020

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