Volunteer Board Bank Application

Volunteer Board Bank
Interest Form

Please fill information as completely as possible.

*Name:

Prefix	First Name	MI	Last Name	Suffix

*Mailing Address:

*Physical (911) Address:

*City, State, Zip:

City	State	Zip

Communications:

Phone (day):

*Phone (evening):

Fax:

E-mail:

Vocation/Profession:

Education/Job Experience(s):

Interests/Community Service Activities:

Board/Commission/Council(s) You Wish To Serve On Selected from Listing:

*1^st Choice:

2^nd Choice:

3^rd Choice:

Others:

Are you interested in serving on more than one group?

Yes No

Current Member of a County Board/Commission/Council(s)?

Yes No If YES, please list below:

Previously Served on a County Board/Commission/Council(s)?

Yes No If YES, please list below:

Registered Voter?

Yes No

*Your District Representative on the Board of Supervisors is:

* Required information

We thank you for your interest in serving on a county board, commission or council.

Back to Boards and Commissions
Back to Gloucester's Home Page