Emergency Management Environmental Commission Green Team Harbor Commission Open Space Committee Other Planning / Zoning Board Recreation Committee Rent Leveling Board Senior Citizen Committee Shade Tree Committee Shade Tree Commission Veterans Affairs Committee

Emergency Management Environmental Commission Green Team Harbor Commission Open Space Committee Other Planning / Zoning Board Recreation Committee Rent Leveling Board Senior Citizen Committee Shade Tree Committee Shade Tree Commission Veterans Affairs Committee

Emergency Management Environmental Commission Green Team Harbor Commission Open Space Committee Other Planning / Zoning Board Recreation Committee Rent Leveling Board Senior Citizen Committee Shade Tree Committee Shade Tree Commission Veterans Affairs Committee

If "Other" please describe

Phone # *

First Name *

State *

City *

Signature *

Last Name *

NOTICE: The recent enactment of the "Citizen Service Act" (A2784) on October 19, 2009, requires any person interested in serving on a municipal authority, board or commission to take an oath of office for that specific position.

By submitting this application, I hereby apply to perform public service on the chosen municipal authority, board, or commissions.

Experience

ZIP *

As per the Citizen Service Act, enacted on October 23, 2009, as P.L. 2009, c.141, any persons filling a position on a board, committee, etc, needs to submit a Citizen Leadership Form to the municipality prior to being appointed to their position.

Address *

Certification

List Education, prior volunteer work, work related experience, or civic involvement experience below which will be useful in this position

If "Other" please describe

Choice 1 *

If "Other" please describe

Choice 2 *

Service Selection

Address, phone number and email shall be deemed confidential for the purposes of P.L.1963, c.73 (C.47:1A-1 et seq.) and P.L.2001, c.404 (C.47:1A-5 et al.)

Please attach your Resume or related qualifications

Applicant Details

Choice 3 *

Email *

Please select the municipal authority, board or commissions in which you wish to perform public service.