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Boards and Commissions ApplicationCITY OF NEDERLAND BOARDS AND COMMISSIONS INFORMATION STATEMENT AND APPLICATION Please check the Board or Commission for which you are applying: Zoning Board of Appeals Civil Service Commission Construction Board of Appeals Planning & Zoning Fair Housing Work Group Economic Development Corporation Parks Advisory Board Other (Please list) ______________ THE FOLLOWING INFORMATION WILL BECOME PUBLIC RECORD IF YOU ARE APPOINTED: Name:____________________________________________________________________ Last First Middle Initial Home Address: ____________________________________________________________ Home Telephone: __________________________ Fax: __________________________ Profession: _______________________________________________________________ Business Name: ____________________________________________________________ Business Address: __________________________________________________________ Business Telephone: ________________________ Fax: ___________________________ PERSONAL REFERENCES: 1)_______________________________________________________________________ Name and Address Telephone 2) _______________________________________________________________________ Name and Address Telephone Voter Registration No: _______________________________________________________ Resident of Nederland for _______________ years. If you have previously served on a City of Nederland Board or Commission, please specify Board or Commission and approximate dates of service: ____________________________ _________________________________________________________________________ Do you have experience that qualifies you for service on a particular Board of Commission (i.e., licenses, degrees, certificates)? Certain Boards require qualifications such as plumbers, architects, electricians: ______________________________________________ _________________________________________________________________________ If you have been involved in any community endeavors, please explain: _______________ _________________________________________________________________________ _________________________________________________________________________ ________________________________ _________________________________ Signature Date QUALIFICATIONS FOR APPOINTMENT TO CITY OF NEDERLAND BOARDS The City of Nederland Policy establishes certain qualifications which must be met by all members of City Boards and Commissions. In addition to any special qualifications for service on a particular board, a board member must: 1)Not be delinquent on any City taxes or utilities. 2)Be a qualified City of Nederland voter, preferred, at the time of appointment. 3)Have been a resident of Nederland for at least six months before the date of appointment unless otherwise allowed by particular board or commission. 4)Have not been finally convicted of a felony. 5)Have not been determined mentally incompetent by a final judgment of court. Thank you for taking the time to complete this application. It will be helpful to the City Council in making appointments. This application must be fully completed for consideration by the City Council You may also attach a resume if you so desire. Please return this form to the address below or fax to 409.723.1550: CITY CLERK P.O. BOX 967 NEDERLAND, TX 77627