Application for Appointment to a Board, Committee, or Commissions for the Town of Dumfries

Application for Appointment to a Board, Committee, or Commissions for the Town of Dumfries

Applicants may only serve on one board or commission at a time unless otherwise specific by town regulations
Required for Consideration: Resume and Letter of Interest*

Cancelof
Board/Committee you are applying:*

Architectural Review Board Board:Board of Zoning AppealsPlanning CommissionEconomic Development Authority
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone*
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Have you ever been convicted of a felony criminal offense?*

YesNo
If yes, please provide the criminal offense
Approximate date of conviction

MonthDayYear
Date
Do you live in the Town of Dumfries?*

YesNo
Are you a business owner within the Town of Dumfries?*

YesNo
Relatives : If you have relatives that are employed by the Town of Dumfries, serves on the Town of Dumfries Town Council, or serves as a member of an agency in which you seek appointment, please list each below (Type N/A if this does not apply to you):*
Qualifications : What are your specific qualifications, skills, and abilities as they relate to the Boards, Commissions, or committee on which you have requested to serve?*
Vision: What is your vision to enhance the Board, Commission, for which you are applying?*
Applications must be returned to the Town Clerk office located at 17739 Main Street, Suite 200 Dumfries , Virginia 22026, or email at nlucas@dumfriesva.gov to confirm submission of the online application.
Please sign and date this form indicating that the information provided above is truthful and accurate. By signing this, you are also giving permission for the Town of Dumfries to complete a proper background check concerning the information provided. If any false information is provided, the applicant will not be considered for appointment and the applicant will be required to reimburse the Town for the cost of the background check. This form and any information collected as a result of any completed background check is confidential and will not be shared or made part of any record.*

Clear
Date*

MonthDayYear
Date
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