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2. 
3. Application for Appointment to City Council
5. Last Name
6. First Name
7. Middle Initial
9. Mailing Address
11. City
12. State
13. Zip Code
15. Street Address
17. City
18. State
19. Zip Code
21. Home Phone Number
22. Work/Message Phone Number
24. Email Address
26. Professional Memberships, Registrations, Licenses, Etc.
28. Education
30. Work Experience
32. Please describe your qualifications for serving on the City Council:
34. List any community service organizations or projects you have been involved with (include a brief description of activities):
36. Are you at least 18 years of age?

    1. Yes
    2. No
38. Are you a citizen of the United States?

    1. Yes
    2. No
40. Are you registered to vote?

    1. Yes
    2. No
42. Have you ever been convicted of, or pled “no contest” to any crime, including any convictions that were later set aside or expunged?

    1. Yes
    2. No
44. Is any relative of yours an employee or public officer* of the City of Cottonwood? *As defined in A.R.S. § 38-101

    1. Yes
    2. No
46. Are you currently a resident of Cottonwood?

    1. Yes
    2. No
48. If yes, how long have you been a resident of the City?
50. NOTE: To be eligible for appointment, a candidate for appointment must be 18 years old, a qualified elector residing within the City, and must have resided within the City for at least one year immediately preceding the appointment.
52. Typed Signature
53. Date
    Date
55. Upload Letter of Interest
56. Upload Resume

58. Please contact City Clerk Tami Mayes at tmayes@cottonwoodaz.gov with any issues submitting this application. If you prefer to submit an application in person, applications may be picked up and/or dropped off at 824 N. Main Street, Cottonwood, AZ 86326.

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

    This field is not part of the form submission.

66. Submit

* indicates a required field