Town of Hopkinton Office of Select Board
330 Main Street, Hopkinton NH 03229-2627 - (603) 746-3170 www.hopkinton-nh.gov
APPLICATION FOR APPOINTMENT
Name: Date:
Address:
Home Phone: Work Phone: Cell Phone:
E‐mail Address:
How long have you lived in Hopkinton?
Is Hopkinton your exclusive domicile? Yes No
If no, explain:
Board/Committee/Position you are interested in being appointed to. (Please list in order of preference if
interested in more than one appointment).
1.
2.
3.
Are you regularly able to attend Board/Committee meetings? Yes No
Please provide a brief explanation for your interest in appointment to a particular board, committee or
position:
Please provide brief background information about yourself. (Please include your experience/work history
with emphasis on experience pertaining to the appointment for which you are applying. Please address any
potential conflicts of interest):
Please provide below the names and telephone numbers of up to three personal references:
Name: Phone:
Name: Phone:
Name: Phone:
I certify that there are no willful misrepresentations of the above statements and answers to the
questions.
Signature:
Date:
Thank you for your interest in serving the Town.
Please return signed application to:
Town Administrator
Town of Hopkinton
330 Main Street
Hopkinton, NH 03229
townadmin@hopkinton-nh.gov
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