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2. Application for (Working Group Name):
4. First Name
5. Last Name
7. Mailing Address
9. City
10. State
11. Zip Code
13. Street Address
15. City
16. State
17. Zip Code
19. Home Phone Number
20. Work/Message Phone Number
22. Email Address
24. Do you belong to an HOA?

    1. Yes
    2. No
25. If you do belong to an HOA, which one?
27. Please list (check below) which items of your personal information we may release to the public, if requested (we recommend at least one):

    1. Mailing Address
    2. Street Address

    1. Home Phone
    2. Work/Message Phone

    1. E-mail Address
    2. HOA
29. Professional Memberships, Registrations, Licenses, etc.:
31. Education:
33. Work Experience:
35. Please describe your qualifications for serving on this Board/Commission/Committee:
37. List any community service organizations or projects you have been involved with (include a brief description of activities):
39. Note: A YES response to the next question will not automatically disqualify applicants from consideration.
41. Does the City of Cottonwood employ any relative of yours?

    1. Yes

    1. No
43. If YES, please explain:
45. Do you currently reside within the city limits of Cottonwood?

    1. Yes

    1. No
47. If YES, how long have you been a resident of the City?
49. Do you currently own a business within the Cottonwood city limits?

    1. Yes

    1. No
51. If YES, what type of business?
53. Note: Applicants are strongly encouraged to attend any interviews in which they may be invited to attend. It is important for the review team to be able to assess applicants' qualifications and backgrounds during the selection process, and be able to ask questions for clarification.
55. The review committee may conduct a brief interview process with the department or Board/Commission they will be reporting to.
57. Date:
    Date:
58. I have filled this application out as completely and accurately as possible and I certify I am the person named on this application.

    1. Yes

    1. No
Leave This Blank:


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

    This field is not part of the form submission.

62. Submit Submit and Print

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