Board/Committee Application Form

2. 

3. Board/Committee Application Form
   for Town of Hinton Boards and Committees

   for Town of Hinton Boards and Committees

7. Personal Information

9. Name

10. Date

12. Application for:

    (Board or Committee you would like to be considered for)

14. Address1

16. Address2

18. City

19. State

20. Postal Code

22. Phone (mobile)

23. Phone (home)

27. Background Information

29. How long have you lived in Hinton or the surrounding area?

31. Please provide an overview of your professional or occupational background:

33. What skills, strengths, or expertise will you bring to this board/committee?

35. Why are you interested in serving on this board/committee?

37. Please list previous experience on boards/committees, or with volunteer positions:

39. Are you currently serving on a board/committee?

    1. Yes

    1. No

41. If yes, please describe below:

45. References

47. Reference #1 Name

48. Reference #1 Email

50. Reference #2 Name

51. Reference #2 Email

55. Confirmation
    I, the above applicant, hereby certify that the information as presented above is truthful and accurate to the best of my knowledge. I understand that offering falsified information may remove my candidacy from the application process.

    I, the above applicant, hereby certify that the information as presented above is truthful and accurate to the best of my knowledge. I understand that offering falsified information may remove my candidacy from the application process.

57. Confirmation*

    Type your name, in full, confirming your understanding of the above message, as well as your understanding of the information collection protocols detailed below.

59. The personal information is being collected under the authority of Section 32 (c) of the Freedom of Information and Protection of Privacy Act and will be used solely for administering the affairs of the Town of Hinton. The privacy provisions of the Freedom of Information and Protection of Privacy Act protect it. If you have any questions about the collection contact the Legislative & Administrative Assistant at 780.740.8059.

    The personal information is being collected under the authority of Section 32 (c) of the Freedom of Information and Protection of Privacy Act and will be used solely for administering the affairs of the Town of Hinton. The privacy provisions of the Freedom of Information and Protection of Privacy Act protect it. If you have any questions about the collection contact the Legislative & Administrative Assistant at 780.740.8059.

Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field