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(* indicates a REQUIRED field)
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*Board/ Commission/ Committee: |
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Please enter name of Board/ Commission/ Committee if not found on the list above
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If this Board/ Commission/ Committee has specific membership representation, for
example, PTO member, business community member, etc, please list your
affiliation (Please list all that apply)
(Separate lines or paragraphs with semicolons ";" to improve readability) |
(Maximum 300 characters)
Please review the applicable
Board/ Commission/ Committee information page to see if
there are any specific
membership representation or affiliation requirements. If
it is required, you will be prompted to enter this information.
(Link opens in a new window) |
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*Applicant: |
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*Home Phone: |
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(AAA-NNN-NNNN) |
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Email Address: |
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*Full Home Address: |
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(NNNNN)
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*Magisterial District in which your
home residence is located: |
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*Employment Status: |
Employment information below is required only if you are currently employed or self-employed. |
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Primary Employer: |
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Phone: |
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(AAA-NNN-NNNN) |
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Business Address: |
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(NNNNN) |
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Occupation/Title: |
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Date of Employment: |
(MM/MM/YYYY)
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*Years Resident in Albemarle
County: |
(NN)
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Previous Residence (if applicable):
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Spouse's Name (if applicable) |
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Number of Children (if applicable) |
(NN)
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*Education (Degree(s) and Graduation
Date(s)):
(Separate lines or paragraphs with semicolons
";" to improve readability) |
((Maximum 300 characters) |
*Memberships in Fraternal,
Business, Church and/or Social Groups:
(Separate lines or paragraphs with semicolons
";" to improve readability) |
((Maximum 300 characters) |
*Public, Civic and Charitable
Office and/or Other Activities or Interests:
(Separate lines or paragraphs with semicolons
";" to improve readability) |
((Maximum 300 characters) |
*Reason(s) for Wishing to Serve on
this Board/ Commission/ Committee:
(Separate lines or paragraphs with semicolons
";" to improve readability)
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((Maximum 300 characters) |
How did you hear about this vacancy?
(Separate lines or paragraphs with semicolons
";" to improve readability) |
((Maximum 100 characters) |
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