APPLICATION FOR BOARDS, COMMISSIONS AND COMMITTEES

This application will provide the information to be considered during the appointment process. Applications are kept on file for two years but will be superseded by any subsequent applications. Completed applications are open to public inspection upon request.

Length of city residence:

Daytime Phone Number

Occupation (If retired list former occupation)

Have you ever been convicted of anything other than a minor traffic violation?

Yes

If yes to above question, please explain:

*DDA Applicants Only

Do You Own Property in the DDA? (Y/N)

Is your place of business in the DDA?

Business name and address

Education:

Reasons:

Qualifications/Community Activities:

References (Name and phone)

Certification/Signature

I certify that there are no misrepresentations, omissions, or falsifications in the foregoing statements and answers, and that the entries made by me are true and complete. I further agree and consent in advance that any misrepresentation or falsification of any of the above information shall be cause, without any hearing, for rejection of this application or termination of appointment, depending upon when the falsification is discovered. I also consent for the City of Royal Oak to verify the information I have provided.

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First Name

Last Name

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