Board Bank Application

Board Bank Application
Full Name:*
Mr., Mrs., Miss, Rank:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address:
example@example.com
Home Phone:
Please enter a valid phone number.
Business Phone:
Please enter a valid phone number.
Cell Phone:
Please enter a valid phone number.
Profession / Vocation:*
Current Employer:*
Which Board(s)/Commission(s) do you wish to serve on?:*

Agency on AgingAlcohol Safety Action ProgramArts Commission of York CountyArts Commission of WilliamsburgBeautification CommitteeBoard of Building Code AppealsBoard of EqualizationBoard of Zoning & Subdivision AppealsChesapeake Bay BoardColonial Behavioral HealthColonial Juvenile Services CommissionCommunity Criminal Justice BoardComprehensive Plan Steering CommitteeCommunity Services Grants Advisory CommitteeEconomic Development AuthorityEmployee Grievance PanelHistorical CommitteeHistorical Triangle Bicycle Advisory CommitteeHistoric Yorktown Design CommitteeLibrary BoardLocal Finance BoardMarquis Community Development AuthorityParks & Recreation Advisory BoardPlanning CommissionSenior Center BoardSocial Services Advisory BoardVirginia Peninsula Community College BoardWetlands BoardWilliamsburg Regional Library Board of TrusteesYouth Commission
Why are you interested in serving on this Board/Commission/Authority?
What specific education, experience or other expertise do you have that makes you well qualified to serve on this Board/Commission/Authority?
Select the highest level of education completed:*

High SchoolAssociate DegreeBachelor's DegreeMaster's DegreeOther
Job experience: *
Are you now or have you ever been active in civic or service organizations? If yes, which organization(s) and in what capacity?: *
Are you currently serving on a Board/Commission?*

YesNo
Please list the Boards/Commissions you are currently serving on:
(If Applicable)
Have you previously served as a member of a York County Board or Commission?*

YesNo
If so, which Board or Commission?
Are you a registered voter?*

YesNo
What district do you live in?*
Should be Empty: