Full Name: Permanent Address: Mailing Address: Phone Number: Type of Phone: Type of Phone: Cell Home Email Address: Preferred method of contact: Preferred method of contact: Mail Phone Email Occupation: Employer: Please choose the Board, Commission, or Committee(s) on which you are interested in serving: Please choose the Board, Commission, or Committee(s) on which you are interested in serving: Budget Committee Board of Appeals Community Health Committee Library Advisory Board Park & Tree Committee Planning Commission Are you applying for reappointment? Are you applying for reappointment? Yes No If yes, how long have you served in this capacity (years & months)? If no, please put "N/A." Do you live within the city limits of Sweet Home? Do you live within the city limits of Sweet Home? Yes No If no, do you live within the Sweet Home School District boundaries? If no, do you live within the Sweet Home School District boundaries? Yes No Please give a brief description of your experiences or training that you feel qualifies you to serve on your selected board, commission, or committee(s) How long have you lived in the area (years & months)? List current involvement in other community groups and/or activities. What special contribution do you feel you can make to the position(s) you are applying for? The following applies for appointments that require residency and elector status: By typing my name, I certify that I currently reside within the corporate limits of the City of Sweet Home and am an eligible elector as defined by ORS 246.012(5). I further acknowledge that should either my residency or my eligibility as an elector change I will notify the City of Sweet Home immediately. CRIMINAL HISTORY BACKGROUND CHECK (CHC): A Criminal History Check (CHC) may be performed as part of the City of Sweet Home appointment process for City Boards, Committees, and Commissions. I acknowledge that a refusal to allow the CHC to be performed, when required, will cause my application to no longer be considered. PUBLIC DISCLOSURE: The City sometimes receives requests for contact information for members serving on City boards, commissions and committees. As an appointed public body volunteer serving the City of Sweet Home, the information provided on this application is considered public record. ELECTRONIC SIGNATURE: I hereby declare that the responses to questions on this form are true to the best of my knowledge and I understand that a CCH may be performed, when required, and that the information provided on this application is considered public record. By typing my full name below, I am electronically signing my application. Date of Signature This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. View PDF of Page
