City of Wilmington, North Carolina > City Clerk

Wednesday, June 19, 2013

Board Application

If you wish to apply for a position on one of our boards, commissions, or committees, you must fill out this online application, or download the PDF application and fax it in.

If an applicant is not selected, their application will be kept on file in the City Clerk's office for Two (2) years and will be considered by the Committee when reviewing and making appointments.

Items in bold are required fields.

SELECT BOARD OR COMMISSION

Request for Appointment to:

CONTACT INFORMATION

Name:

Home Address:

Mailing Address:

Street Address:

Business Address:

Email Address:

Cell Phone:

Home Phone:

Business Phone:

BACKGROUND INFORMATION

How long have you been a resident of the City of Wilmington:

Employed By:

Job Title:

Duties Performed:

Professional Activities:

Volunteer Opportunities:

Why do you wish to serve on the Board, Committee, or Commission requested?:

What do you feel are your qualifications for serving on the Board, Committee, Commmission requested?:

What areas of concern would you like to see the Board, Committee, or Commission address?:

Are you currently serving on another board or committe appointed by a municipality or county? If so, please list.:

DEMOGRAPHIC INFORMATION

This information is requested for the sole purpose of assuring that a cross-section of the community is appointed.

Race:

Age:

Sex:
M
F

PERSONAL REFERENCES

Please list three (3) local personal references, names, and telephone numbers

Reference 1 Name:

Reference 1 Phone:

Reference 2 Name:

Reference 2 Phone:

Reference 3 Name:

Reference 3 Phone:

SIGNATURE AND DATE

By checking this box I certify that this serves as an electronic version of my signature, for the sole purposes of this form:

Date:

Select Date

102 North Third Street - Post Office Box 1810
Wilmington, North Carolina 28402-1810
910.341.7800
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