| BOROUGH OF SOUTH PLAINFIELD | ||
| APPLICATION FOR APPOINTMENT TO | ||
| VARIOUS BOARDS, AGENCIES, COMMITTEES AND COMMISSIONS | ||
| Please read and complete the entire application | ||
| Personal Information | ||
| Name ________________________________________________________________________________ | ||
| Home Address _________________________________________________________________________ | ||
| City ________________________________________________ State ___________ Zip ______________ | ||
| Home Phone ______________________________E-Mail _______________________________________ | ||
| Are you 18 years of age or older? Yes __________ No __________ | ||
| Experience and Education | ||
| Civic Activities (include other boards, agencies, committees and commission):_________________________ | ||
| _____________________________________________________________________________________ | ||
| _____________________________________________________________________________________ | ||
| _____________________________________________________________________________________ | ||
| Degree and school attended:_______________________________________________________________ | ||
| Resume attached (optional): [ ] | ||
| Statement of Interest | ||
| For which board, agency, committee or commission would you like to be considered? | ||
| _____________________________________________________________________________________ | ||
| Please write a brief statement explaining your interest in the board, agency, committee or commission for which | ||
| you are applying. Include any experience, training, and/or qualifications you have relating to this board, agency, | ||
| committee or commission. ________________________________________________________________ | ||
| ________________________________________________________________________________________________________________________________ | ||
| ________________________________________________________________________________________________________________________________ | ||
| ________________________________________________________________________________________________________________________________ | ||
| Please indicate any conflicts of interest you may have if chosen for this board, agency, committee or | ||
| commission:___________________________________________________________________________ | ||
| _____________________________________________________________________________________ | ||
| _____________________________________________________________________________________ | ||
| In accordance with the Local Government Ethics Law (N.J.S.A. 40A:9-22 et seq.) annual Financial | ||
| Disclosure Statements must be filed by elected official, certain government employees, and members | ||
| of the housing authority, recreation commission, planning board. Zoning board, board of health, | ||
| board of education and library board of trustees. Financial Disclosure Statements indicate the source | ||
| of income but not the amount. | ||
| Information submitted on this application is public information. I verify that the information provided | ||
| herein is true and complete. I understand that false and misleading statements may be cause for | ||
| elimination from consideration. | ||
| Applicant Signature _____________________________________________ Date ______________ | ||
| Return completed applications Monday through Friday, 8:00 a.m. - 4:00 p.m. to: | ||
| Borough Clerk's Office | ||
| Borough of South Plainfield | ||
| 2480 Plainfield Avenue | ||
| South Plainfield, New Jersey 07080 | ||
| or E-Mail to: jgraf@southplainfieldnj.com | ||