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Application for Commitee, Commission or Board
Date
*
field type date
Date will be captured on form submission
Application for:
field type checkbox
Application for:
Planning & Zoning Commission
Landmark Commission
Board of Police Commissioners
Police Pension Board
Ethics Commission
Other
Name
*
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Address
*
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Phone
*
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Email
*
field type email
City Resident Since:
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Other Elected or Appointed Positions Held
field type multi line
Please also note if Present or Former positions
Organization Membership
field type multi line
List any organizations you are a member of, and list any offices held
Occupational Background
field type multi line
Formal Education
field type multi line
Governmental Business Relationships
field type checkbox
Do you or any of your close family or business connections own, hold stock in, serve as director of or work for any business which provides products or services to:
Governmental Business Relationships
City of McHenry
Other Governmental Entity
Neither
Relationship Explanation
field type multi line
Please explain
Committee/Board Connections
field type radio button
Do you or any of your close family or business connections serve on any Committee, Commission, Board or otherwise with an organization or agency which has, or may have, any business or personal transactions with the Committee, Commission or Board to which you are making application?
Committee/Board Connections
No
Yes
Relationship Explanation
field type multi line
field type radio button
Are you generally familiar with the functions and workings of the Committee/Commission/Board to which you are making application?
Yes
No
field type multi line
What prompted you to apply for consideration of appointment to this position?
field type multi line
What studies, responsibilities, accomplishments, publications or community projects have you participated in or initiated which you feel may qualify you for this position?
field type multi line
Other Comments
field type multi line
Other information you would like to include may be attached to this application. The Mayor, being responsible for appointments to Committees/Commissions/Boards will interview each applicant personally. What day and times are you available?
File Upload
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Signature
*
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