Boards and Commissions

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Name

Board or Commission

Address

City/Town

State/Province

ZIP/Postal Code

Email Confirmation

Confirm email

Phone Number

I am at least 18 years of age:

Yes

I am currently registered to vote:

Yes

Employer:

Employer's Phone Number:

Title and brief description of your work:

Education Level and Degrees received:

I presently or previously held the following appointments or positions:

Have you ever been convicted of a felony? If yes, list each, giving date, nature of offense or violation, name and location of court, the penalty imposed, if any, or the disposition of the case. A conviction will not automatically bar you from an appointment.

Do you have a conflict of interest or potential conflict of interest such as financial or business interest in any contracts, grants, permits, etc. with the City of Menominee? If so, list the interest (except where required ofr the appointment).

Lost any family members who are or have been employed by City of Menominee, Menominee County or are or have been elected to City offices.

Breifly indicate your qualifications for appointment to this specific board or commission and why you believe your appointment will benefit the City of Menominee.

I do hereby apply for appointment to the above board or commission above and do swear or affirm that (1) if appointed, I will comply with all statutory and other requirements and obligations of my appointment; (2) if I cease to comply iwth such requirements, I automatically forfeit said appointed position; (3) I hold no position or appointment which is a conflict of interest with the appointed position applied for; and (4) to the best of my knowledge and belief, I possess the requisite qualifications for the office I am seeking.

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