Greenville, NC

CANDIDATE’S REQUEST FOR APPOINTMENT TO BOARDS OR COMMISSIONS OF THE CITY OF GREENVILLE

I live within the city limits of Greenville, North Carolina and would like to be considered for appointment to the following board(s): (If applying for more than one, please list the boards in the order of your preference.) 

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I live within the city limits of Greenville, North Carolina and would like to be considered for appointment to the following board(s): (If applying for more than one, please list the boards in the order of your preference.)

1.

2.

3.

4.

Candidate Info

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Candidate Info

Name

Home Street Address

City

Zip

Home Phone Number

Business Phone Number

Fax Number

E-mail Address

Employed By

Occupation

Name of High School Attended

College/University Attended

Degree Received

How long have you been a resident of Greenville?

Sex

Sex

Male

Female

What is your City Council District?

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What is your City Council District?

1

2

3

4

5

Have you served on a board/commission of the city?

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Have you served on a board/commission of the city?

Yes

No

If yes, please indicate which one(s) 

If yes, please indicate which one(s)

Are you currently serving as an elected or appointed official?

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Are you currently serving as an elected or appointed official?

Yes

No

If yes, please explain:

If yes, please explain:

Current membership in organizations and offices held

Current membership in organizations and offices held

Past membership in organizations and offices held

Past membership in organizations and offices held

State why you feel you would be an asset to this board/commission

State why you feel you would be an asset to this board/commission

Please review and acknowledge the following:

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Please review and acknowledge the following:

I acknowledge that information submitted on this form is subject to public records requests

I acknowledge that applications are kept for a period of two calendar years. Applicants that are interested in maintaining a current application in the talent bank pool should re-submit their applications accordingly.

If appointed to serve on a board or commission, I agree to attend the required number of meetings each calendar year and not to miss more than 25% of the meetings or more than three meetings in a calendar year. 

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I agree

Signature and date are required for submission.

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Signature and date are required for submission.

Signature

Date

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This information requested below is optional.

 Ethnic Group 

Ethnic Group

African American

American Indian

Asian or Pacific Islander

Caucasian

Hispanic

Birth Date

Birth Date

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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