Volunteer Application Form

VOLUNTEER APPOINTMENT
APPLICATION

The Village of River Hills welcomes residents interested in serving on our Boards, Commissions or Committees. If you would like to contribute your skills, talents and time on behalf of our community, please complete and submit the form below. If you prefer to hand in a paper form you can use the link above to download a printable pdf.

I would like to be appointed to:
(Please list first, second and third choice)

1	2	3
			BOARD OF APPEALS
			COMMITTEE ON THE ENVIRONMENT
			BOARD OF HEALTH
			PLAN COMMISSION
			BOARD OF REVIEW
			BUILDING BOARD
			COMMUNITY RELATIONS COMMITTEE

NAME

HOME ADDRESS

HOME PHONE

OFFICE PHONE

E-MAIL

OCCUPATION

HOW LONG HAVE YOU BEEN A VILLAGE RESIDENT?

WHY DO YOU WANT TO SERVE ON THIS BOARD OR COMMITTEE?

ARE YOU FAMILIAR WITH THE RESPONSIBILITIES OF THE SPECIFIC BOARD?
yes
no

HAVE YOU OBSERVED ANY MEETINGS OF THIS BOARD?
yes
no

PLEASE INDICATE ANY PUBLIC OR APPOINTIVE OFFICE HELD.

WOULD YOU HAVE ANY POTENTIAL CONFLICT OF INTEREST?
yes
no

IF YES, DESCRIBE:

I AGREE TO ADHERE TO THE VILLAGE CODE OF ETHICS.
yes
no

DESCRIBE BRIEFLY YOUR EDUCATION AND ANY WORK EXPERIENCE OR OTHER ACTIVITY WHICH IN YOUR OPINION WOULD BE BENEFICIAL IN CARRYING OUT THE RESPONSIBILITIES OF THIS OFFICE.

IF APPOINTED TO THIS OFFICE, ARE THERE ANY OTHER ACTIVITIES IN WHICH YOU ARE NOW ENGAGED WHICH WOULD INTERFERE WITH YOUR REGULAR ATTENDANCE UPON THE DUTIES REQUIRED? IF SO, TO WHAT EXTENT?

IF APPOINTED I WILL MAKE EVERY EFFORT TO ATTEND ALL MEETINGS OF THE GROUP.

DATE

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