APPLICANT MUST BE RESIDENT OF COWETA COUNTY

1

Name

 *

Name

First Name

Last Name

2

Address

 *

Address

Mailing Address

Street Address (If Different From Mailing Address)

3

Phone

 *

Phone

Home Phoneext.

Cell Phoneext.

4

Which number is best to reach you ?

 *

Which number is best to reach you ?

Home

Cell

5

What is the best time to reach you?

What is the best time to reach you?

6

Email Address

 *

Email Address

7

Is there a particular Board/Authority you would be most interested in? Please note preference below, or answer "any."

Current Boards, Authorities & Committees List

 *

Is there a particular Board/Authority you would be most interested in? Please note preference below, or answer "any." Current Boards, Authorities & Committees List

8

What days and/or hours are you available to attend any Board/Authority meetings if you should be appointed to serve?

 *

What days and/or hours are you available to attend any Board/Authority meetings if you should be appointed to serve?

9

Please provide a brief explanation of any relevant experience of skills that you feel would be beneficial to to the operation of the Board or Authority

Please provide a brief explanation of any relevant experience of skills that you feel would be beneficial to to the operation of the Board or Authority

10

Are you currently serving on another Board/Authority?

 *

Are you currently serving on another Board/Authority?

No

YES (please list) If other, type text here.

11

Are you an immediate family member of a current elected official or any employee of the Coweta County Board of Commissioners?

 *

Are you an immediate family member of a current elected official or any employee of the Coweta County Board of Commissioners?

No

Yes (please provide name) If other, type text here.

I have answered the above questions to the best of my ability and by submitting this form, I approve the information to be placed into a database to be used solely for the purpose of selecting members to Boards and Authorities under the auspices of the Coweta County Board of Commissioners.

Page 1 / 1