HONESDALE BOROUGH
COUNCIL VACANCY APPLICATION FORM
APPLICANT INFORMATION
Full Name:
*
Address:
*
Phone Number:
*
Format: (000) 000-0000.
Email Address:
*
example@example.com
ELIGIBILITY
Are you a resident of Honesdale Borough?
*
Yes
No
Are you 18 years or older?
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Yes
No
Are you a resident in Honesdale Borough for a minimum of one year?
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Yes
No
Are you a registered voter in Honesdale Borough?
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Yes
No
Do you currently hold any other elected, appointed, or public office?
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Yes
No
If yes, please explain:
Do you have any actual or potential conflicts of interest that may affect your ability to serve as a Council Member?
*
Yes
No
If yes, please explain:
Are you able to attend all regularly scheduled Borough Council meetings? (currently 4th Monday of Each Month)
*
Yes
No
REQUIRED ATTACHMENTS
Please attach the following documents:
Cover Letter
*
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Resume
*
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APPLICANT CERTIFICATION
I certify that the information contained in this application and any attached documents is true and complete to the best of my knowledge. I understand that any false statement or omission may result in disqualification from consideration.
Applicant Signature:
*
Date:
*
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Month
-
Day
Year
Date
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