Application for Appointment of Board, Commission, Committee

2. 

4. Application for Appointment Board, Commission, Committee

   Application for Appointment Board, Commission, Committee

6. First Name:*

7. MI*

8. Last Name*

10. Address*

12. City*

13. State*

14. Zip*

16. Email

17. Home Phone*

18. Cell Phone

20. List in order of preference, Committee(s) to which you would like to be appointed

22. Committee 1*

23. Committee 2

25. Committee 3

26. Committee 4

28. State reasons justifying your appointment to the above Committee(s). What do you see as the objectives and goals of the Committee to which you seek appointment?*

30. Community Services: List prior public service, volunteer activities, or Boards, Commissions, Committees currently serving or having served; offices held and in what Township or City:*

32. Employment: Title and duties, current and past*

34. Education: List Diploma, Degree or Certificate, Institution and Course of Study*

36. Have you ever worked for the Township of Howell? *

    1. Yes

    1. No

38. Have there been, or are there now, any personal or business circumstances which might reflect adversely on the propriety of your serving as a member of any Township board to which you might be appointed? (If yes, please explain on a separate sheet if necessary.)*

    1. Yes

    1. No

40. Have you ever been convicted in any jurisdiction of (a) a felony or (b) a misdemeanor other than a minor traffic violation?*

    1. Yes

    1. No

42. (If the answer to either question (a) or question (b) is “yes”, please provide the details of each conviction, including the date of conviction, and the court and jurisdiction in which you were convicted. Use a separate sheet if necessary). Howell Township reserves the right to conduct a criminal background check on each applicant. Howell Township may, but will not necessarily, reject an applicant because of a record of criminal conviction.

44. In accordance with the Local Government Ethics Law (NJSA 40A:9-27.1 et. seq.) an Annual Financial Disclosure Statement must be filed by certain elected and appointed officials. Financial Disclosure Statements indicate the source of income but not the amount.

46. Information submitted on this application is public information

48. I hereby certify that the information contained in the application is correct to the best of my knowledge. I hereby certify that I am qualified to hold the position for which this application is made. I understand that false or misleading statements may be cause for elimination from consideration. Further, I understand that the Howell Township Council may suspend any Township board member who is arrested for a felony or for a misdemeanor related to the duties of appointment or who is indicted or reformed against for the commission of any felony or misdemeanor.

50. Date:*
    Date:

51. Signature:*

    Typing your Name Certifies you are signing and Certifying this Application

Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit Submit and Print

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