HomeMy WebLinkAboutApplication for appointed Board-fillable Name of Advisory Group
Seat Title Term Length
TOWN OF LANSING
APPOINTED BOARD APPLICATION
Please type or print in black ink
If you are interested in serving as a member of an advisory group please complete this form;attach additional sheets if necessary.You may be
called for an interview and you may wish to attend a meeting of the advisory group if you have not yet done so.
Name Date of application
Address(residence)
Street City Zip Code
Telephone(home) (work) (mobile) (fax)
Email address Length of residence in Town/Village of Lansing
Occupation(s)/name and location of business
Education
schools(degrees)and specialties
Why are you interested in this position?
What particular strengths would you bring to this position?
Experience and community affiliations
Recommended by
If organization or municipality, include name of entity, contact person,and telephone number;if another individual(s),give
name(s)and telephone number(s).
References: (1)
name,address,and telephone number
(2)
name,address, and telephone number
Signature of Applicant
Office use only
Type of appointment: new or reappointment Replacing: (if new) Term expiration date
Seat Title:
Town Board Appointment Date Appointment letter mailed date
Town of Lansing