Type Full Name :
Sign With Hand
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.

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 *
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
{[CITY]}, {[STATE]} {[ZIP]}
Applicant Details
{[PNAME]} Application
Choice 3 *
Email *
Please select the municipal authority, board or commissions in which you wish to perform public service.