Application for Board Appointment
We consider applicants for vacant board positions without regard to race, religion, sex, nationality,
origin, age, marital or veteran status, disability, or any other legally protected status.
Select Postion
Board Position Applied For: ___________________________________________________
Date: _______________
Personal
Name: ___________________________________________________
Address: ___________________________________________________
City: ____________________________ State: _______________ Zip: _______________
Home Phone: ____________________________ Work Phone: ____________________________
Have you ever served on a City Board before?
How long have you been a resident of Hamlet
Yes
No
Yes
No
_____
Are you a citizen of the United States?
Present Employer: ____________________________ Job Title: ____________________________
High School: ____________________________ College: ____________________________
Have you ever been convicted of any crime
other than a minor traffic violation?
Yes
Memberships
Current Membership in Organizations and Offices Held:
No
Past Organizational Membership and Offices Held:
Previous Service on any City Board/Commission:
List Names & Dates
Do you anticipate a conflict of interest by serving as a member of any board?
Yes (if yes explain)
No
References
1.
2.
3.
Additional Information
List any skills, special qualifications, or work experience you feel would be beneficial if appointed to this
position:
State any additional information you feel may be helpful to us in considering your application:
Applicant's Certification
I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation
of all statements contained in this application and release pertinent information to the City of Hamlet. I
understand that false or misleading information given in my application may result in it not being considering
for appointment. I understand, also, that I am required to abide by all rules and regulations of the City of
Hamlet.
Recommendations from the perspective board and information on the application may be considered by the
Hamlet City Council when making appointments. It may also be used for a news release to identify you to the
community. Your application will be kept on file and considered for each appointment. You will be responsible
for keeping information on the application current; i.e. address and phone number. You will also be responsible
for notifying city staff if you no longer wish to be considered and would like your application withdrawn.
Signature: ___________________________________________________
Date: _______________
Office Use Only
Board's Recommendation: ___________________________________________________
Board Appointed to Serve: ___________________________________________________
Date of Appointment: _______________