Village of Brooklyn Village Board
Application for Appointment to Village Board or
Committee/Commission
For what position are you seeking appointment?
Village Board Trustee
Citizen member of committee/commission
(Name of committee)
Your Name:
(First name, middle initial, last name)
Home Street Address:
Telephone: Home: Work:
Cell:
E-mail Address:
Do you reside within the corporate limits of the Village of Brooklyn? Yes No
Occupation: Employer:
Employer’s Address:
Have you ever been convicted of any felony? (Answer only if applying for appointment
to Village Board) Yes No
Briefly state why you are interested in and why you feel you are qualified to serve in the
position.
Appointment Approved:_______________
Oath Sent:_______________
Oath Returned:_______________
Distribution List Updated:_______________