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Application for Board or Commission Appointment

Application for Board or Commission Appointment
Citizens can bring valuable insight and provide skilled resources to local government by serving on city Boards and Commissions. The citizens appointed to serve on these volunteer organizations represent the views of all citizens to the Mayor and Council. In this role, they make decisions and help recommend and review policies for the City of Lilburn. This questionnaire will assist the City Council in its review process to determine applicant eligibility and qualifications for Board or Commission appointments.
Please seriously consider these questions before applying for membership on a Board or Commission:
• Do I fully understand the role and responsibilities of this Board or Commission? Am I willing to spend my time, skills and energy on the goals and mission of this Board or Commission including preparation for and regularly attending meetings?

• Do I have skills and experience that will be useful on this Board or Commission?

• Am I willing to perform a reasonable amount of work outside of regularly scheduled Board or Commission meetings?

• Can I work effectively with the other members of the Board or Commission?

• Am I willing to participate in necessary Board or Commission training, education and development activities that will improve my effectiveness in my position? Note that the city pays for training seminars and associated expenses to improve a member’s knowledge of a Board or Commission role and responsibilities. In addition, most Board and Commission members receive a small honorarium for attending regular board meetings.
Boards and Commission Information
Boards and Commission Information
Process for Selecting Members of Boards, Commissions, and Committees
Process for Selecting Members of Boards, Commissions, and Committees
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Personal Information

Select the Board, Commission, or Committee applying for*
Title
First Name*
Last Name*
Home Address*
City*
State*
Zip*
Home Phone Number*
Cell Phone Number*
Preferred E-Mail*
Occupation:*
Employer*
Length of Residency in the City of Lilburn*
Proof of Residency in Lilburn*
Are you a registered voter in the State of Georgia?*
1. Yes
2. No
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Questionnaire

Questionnaire
Are you currently serving on other Boards or Commissions?*
1. Yes
2. No
If yes, which
Have you served on a Board or Commission before?*
1. Yes
2. No
If yes, which
Please list organization memberships and positions held
Please List Areas of Special Interest
Please briefly explain your reasons for wishing to serve on a Board or Commission?*
What skills and experience do you have that can be applied to the mission and goals of the Board or Commission? *
Will you have the time and availability to prepare for and regularly attend meetings, to attend training sessions provided by the City on-site and/or off-site, and to perform a reasonable amount of work outside of regularly scheduled meetings?*
Do you know of any circumstances that would create a conflict or result in you having to abstain from voting on any action before a Board or Commission?*
1. Yes
2. No
If yes, please explain:
Comments
Please attach any additional info you wish to provide .
From time to time, the council and Mayor are asked to appoint citizens to committees and task forces which are generally asked to address a specific issue. Would you be interested in participating in one or more of these?*
1. Yes
2. No
If yes, what topics would interest you?
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Signature Page

I understand that I am applying for appointment to a Board or Commission of the City of Lilburn. I further understand that:
1. The appointing authority may require an interview prior to consideration for appointment;

2. That I will be required to take an oath of office to uphold the City’s charter and ordinances;

3. That my term in office will be governed by the by-laws of the Board or Commission to which I am appointed;

4. In addition, that my application is a public record and will remain on file with the City Clerk.

By signing this form, I agree to comply at all times with all requirements of the office for which I am applying and to which I may be appointed. All statements and information provided in this application are true to the best of my knowledge.
Signature*
Date Signed*
Date Signed

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1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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