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3. 
5. Contact Information
7. First Name*
8. Last Name*
10. Home Address*
12. Address2
14. City*
15. State*
16. Zip*
18. Phone Number
20. Email Address
22. Education Background
24. High School Name
25. Year Graduated
27. College Name (if applicable)
28. Year Graduated
30. Post-Graduate Work
32. Additional Training
34. Employment History
36. Current Employer
37. # Years of Employment
39. Position/Title
41. Current/Past Volunteer Positions
    Please include number of years you served in each volunteer position
43. Organization/Service Club Membership
    Please include number of years you were a member of each organization/service club and and offices you held.
45. Other Biographical Information
47. I Am Interested In Serving On The Following Board(s)

    1. Airport Advisory Board
    2. Board of Building Code Appeals
    3. Citizens Peer Review Committee
    4. City Planning Commission
    5. City Tree Board
    6. Civil Service Commission
    7. Community Reinvestment Area Housing Council
    8. Compensation Commission
    9. Downtown Design Review Board
    10. Enterprise Zone Tax Incentive Negotiating Team
    11. Greater Downtown CRA Housing Council
    12. Income Tax Board of Appeals

    1. Local Board of Tax Review
    2. Paint the Town Committee
    3. Personnel Board of Appeals
    4. Records Commission
    5. Recreation Board
    6. Regional Planning Commission
    7. Revolving Loan Fund Screening Committee
    8. Shelby Metropolitan Housing Authority
    9. Sidney-Shelby Economic Partnership Council
    10. Sidney Special Energy Improvement District
    11. Stormwater Appeals Board
    12. Zoning Board of Appeals
49. Boards and Commissions Page
    Boards & Commissions Page

    For more details on each board, please follow the link above.
51. Date*
53. Signature*
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55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit Submit and Print

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