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Board Appointment Application
NAME OF APPLICANT :
APPOINTMENT APPLYING FOR:
Please describe any relevant experience in the areas served by this Board
Are you related to any current employee of Sylvania Township:
Name and Position:
Are you related to any other member or employee of the committee, commission, board or agency for which you are applying?
Do you serve on any other public or not-for-profit boards?
Are you a defendant or plaintiff in any pending civil law suits that could impact your service on this public board?
Have you ever been convicted of a violation of any law, other than minor traffic offenses? If so, please provide details:
Date of Graduation
Post-High School Education
Present or last employer:
Dates of Employment:
Previous employment (list employers, position, dates of employment)
(List three persons not related to you who you have definite personal knowledge of your qualifications for this position)
Please provide a brief statement as to why you feel you are qualified for this appointment. If you are seeking re-appointment, please indicate what your contributions have been to the committee/commission during the time of your service. For reappointment, please state your meeting attendance history.
Please include any other information here that you feel would be of importance to the Trustees in the selection process.
Are you aware of any circumstances that exist or could exist that would create a conflict of interest or the appearance of a conflict of interest if you are appointed to this board?
SIGNATURE OF APPLICANT
I certify that the statements made by me in this application are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I understand that any false statements will void this application and any actions based on it.
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