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Application for Board Appointment
This form has been modified since it was saved. Please review all fields before submitting.
Community/Commission Applying For
Are you related to a current employee of the Court?
If yes, give name and position
Have you ever been convicted of a violation of any law, other than a minor traffic offense? (DUI convictions must be disclosed.)
If YES, Describe
High School Education
Post High School Education
Present or Last Employer
Start and End Date of Employment
Start and End Date of Employment Start Date
Start and End Date of Employment End Date
Previous Employment (list employers, position, dates of employment)
REFERENCES: (List three persons not related to you who have definite knowledge of your qualifications for this position)
Person 1 - Full Name
Person 1 - Phone Number
Person 1 - Address
Person 2 - Full Name
Person 2 - Phone Number
Person 2 - Address
Person 3 - Full Name
Person 3 - Phone Number
STATEMENT: Please provide a brief statement as to why you feel you are qualified for this appointment. If you are seeking re-appointment, please indicate what your contributions have been to the committee/commission during the time of your service.
I certify that the statements made by me in this application are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I understand that any false statements will void this application and any action based upon it. Further, I authorize the Court to conduct a criminal history check and have provided my social security number for that purpose.
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