Board Member Nomination and Application

form.antibot { display: none !important; } You must have JavaScript enabled to use this form.

Date

edit-submitted-date-month

edit-submitted-date-day

edit-submitted-date-year

Contact Information

Applicant full name *

Enter full name.

Email Address *

Enter your full email address.

Home Address *

Enter your home address, city, state and zip.

Work Address

Enter full work address, city, state and zip.

Cell Phone *

Work Phone

Preferred Address: Would applicant prefer home or work address used as mailing address?

Work

Home

None

Do you prefer to have your personal contact information remain private? *

Yes

Board Application

Name of Board you are applying for *

Enter the name of the board you are applying for.

Nominated by (if applicable)

Unique qualifications and/or perspectives you would bring to a Board or Commission: *

Are you a current member of another board(s). If yes, please list board names.

Have you ever been a member of another board(s)? If yes, list board and dates.

Additional Information

Are you or any of your family members a White City Metro Township employee?

Yes

Have you ever been convicted of a felony? Answer yes or no. If yes, please explain. *

Submit your Resume here as an attachment.

You may submit your resume as a PDF, Doc, Docx, or Text document.
Files must be less than 2 MB.
Allowed file types: tif txt pdf doc docx.