HomeMy WebLinkAboutItem 10 - Mid-Year Library Board Appt.ITY OF GRAPEVINE
BOARD AND COMMISSION APPLICATION
BOARD OR COMMISSION: ______________________________________________
Use a separate application for each appointment desired.
Name: Ms. Mrs. Mr. Dr. ______________________________________________________
Address:_________________________________________________________________
Cell phone:________________________ Work phone:_________________________
Employer: ________________________________________________________________
Occupation: _______________________________________________________________
Grapevine Resident ______Years Tarrant Co. Voter Registration No.______________
E-mail Address: ________________________________________________
Why are you interested in being appointed to this board/commission?
List any City service and experience, civic organizations, as well as professional activities.
What is your educational and occupational experience?
What other knowledge, experience, or education do you have that is applicable to the
board/commission function?
Please return completed application to the City Secretary’s Office:
By mail: PO Box 95104, Grapevine TX 76099
By fax: 817-410-3004 I By email: tbrooks@grapevinetexas.gov
What do you believe will be your most significant contribution to the board/commission?
What else would you like to tell us about yourself?
List the name and phone number of one Grapevine resident, City staff, City Council, or current
Committee member who may be contacted on your behalf.
Number of Board/Commission meetings attended in past 12 months ______
Number of City Council meetings attended in past 12 months ______
Have you ever entered a guilty plea or no contest or been convicted of a crime in a civilian or
military court or received a deferred adjudication (not including traffic violations)? ________
If yes to the above question, what offense(s) and counties/states/dates? If this is not applicable,
type “NA”. (A criminal record will not necessarily disqualify you from appointment).
I understand that by signing this application my attendance will be required at all
committee meetings.
Signature: _____________________________________________
Date: ______________________
In order to allow greater participation in the City government, board appointments are limited
to one member per household. Spouses will not be appointed to serve on boards, either the
same board or a different board.