2. Committee Application

   
   Fill out this form to apply for consideration to be on one of Monroe's committees or boards.

   Please attend a meeting of the Committee or Board of interest before completing and submitting your application. This application will be kept in active status for one year from date of application.

   Contact Sherry Hicks for more information.

3. 
5. Committee/Board Seeking Appointment*
   -- Select One --ABCAnimal Welfare CommitteeBoard of AdjustmentAirport Advisory CommissionCommittee on DisabilitiesDowntown Advisory BoardEconomic Development Advisory BoardHomeless and Addiction CommitteeMonroe Historic District CommissionMonroe Housing AuthorityMonroe Tourism Development AuthorityParks and Recreation Advisory CommissionPlanning BoardUnion County Historic Preservation CommissionWinchester Revitalization Committee
7. Applicant's Name*
9. Street Address*
11. City*
12. State*
13. Postal / ZipCode*
15. Applicant's Email*
16. Applicant's Phone*
18. Residency Information*

    1. City
    2. County
19. Are you a US citizen?*

    1. Yes
    2. No
21. Have you attended any meetings of the Committee/Board of interest?*

    1. Yes
    2. No
23. I understand that I cannot apply for a position on a Committee or Board if I have not attended a meeting.*

    1. I understand.

    Please attend a meeting of the Committee or Board of interest before completing and submitting your application.

25. List dates of meeting(s) attended of the Committee/Board of interest.*
27. Education: List schools, dates attended, degrees obtained.*
29. Occupation: List past 3 and current employers and positions held.*
31. Please list civic and fraternal organizations in which you participate in Monroe/Union County.*
33. Business and civic experience/skills relevant to the Committee/Board seeking appointment:*
35. Areas of expertise/special skills relevant to the Committee/Board seeking appointment:*
37. Please explain your interest in serving on the above named Committee/Board.*
39. Are you currently serving on any other appointed bodies?*

    1. Yes
    2. No
40. If yes, please list.
42. Do you currently hold an elected office?*

    1. Yes
    2. No
43. If yes, please list.
45. Could any of your business or personal interests create a conflict (either real or perceived) if appointed?*

    1. Yes
    2. No
46. If yes, please explain conflict.
48. Has any formal charge of professional misconduct ever been sustained against you in any jurisdiction?*

    1. Yes
    2. No
49. If yes, please explain complete disposition.
51. Have you completed the City's Citizen's Academy?*

    1. Yes
    2. No
52. If yes, when did you complete the academy?
54. Have you ever been convicted of a crime other than minor traffic offenses?*

    1. Yes
    2. No
55. If yes, explain.

57. Submit Resume

59. Please attach a copy of your resume/curriculum vitae.

    If you are applying for reappointment and there are no changes, a resume/curriculum vitae is not required provided your resume has already been submitted.

61. Please contact Sherry Hicks for more information.

    I understand that this application will be kept in active status for one year from date of application.

    I certify that the information provided in this application is true and correct to the best of my knowledge. I authorize and consent to background checks and to the investigation and verification of all information contained herein. I further authorize all persons having information concerning my qualifications to release information to city representatives and release such persons from all liability for any damages connected with the release of such information. I also release and discharge the City of Monroe from any claims and damages, losses, liabilities, costs, expenses or any other charges or complaints arising out of the City's use of any information provided pursuant to this release. I understand and agree that any misstatement will be cause for my removal from any board or committee. By submitting this application, I agree to adhere to all city policies pertaining to boards and commissions, including attendance. I hereby acknowledge that this application and information provided herein may constitute a public record, pursuant to North Carolina's Public Records Law, NC.G.S. 132-1, et. seq., and as such, may be released in accordance with all applicable public record laws.

63. By signing and submitting this document, you agree that all signatures where required may be Electronically Signed by either party, pursuant to NCGS 66-315(b).*

    1. I understand
65. Signature*
66. Date*
    Date
Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit

* indicates a required field