Board, Commission, and Committee Application Applicant Name Home Address Mailing Address (If different) Home Telephone Number Email Address Are you over the age of 18? Yes No Are you a registered voter? Yes No Are you a Justin resident, property, business owner, or City Staff? Yes No Current occupation/employer Education, licenses, or certifications Are you a current or past member of a Council-appointed Board, Commission, or Corporation? Yes No If yes, please specify On which Board, Commission, or Committee are you intersted in serving? (First Choice) Planning & Zoning CommissionParks & Recreation BoardJustin Community Library BoardType A Economic Development BoardType B Community Development BoardKeep Justin Beautiful Committee If you have a second choice for a Board, Commission, or Committee on which you would like to serve, please also select that below N/AParks & Recreation BoardJustin Community Library BoardPlanning & Zoning Commission What work experience, educational experience, community involvement, and/or other skills do you have that would qualify you for a Council-appointed Board, Commission, or Committee? List any additional information which you believe would be of value for the City Council to know about you Do you or any member of your immediate family residing in your household, hold a position (paid or unpaid) with any person or organization, or have a contract with or any obligation to any person or entity which might constitute a conflict of interest Yes No If yes, please explain Have you ever been convicted of a felony, violation of law, or misdemeanor involving moral turpitude (any offense involving lying, stealing, or cheating?) Yes No Are there any criminal charges or proceedings pending against you? Yes No By typing your full name in the box below, you acknowledge that the information provided is correct to the best of your ability. Please select the date of submssion of this form.