Boards and Commissions Forms

CITY OF FARMINGTON APPLICATION
Boards/Commissions

OFFICE OF THE MAYOR
(505) 599-1157 OFFICE
(505) 599-8430 FAX

Personal Information
Name:	Home Phone:
Home Address:	City:
E-Mail:	Fax:
Business:	Business Phone
Business Address

Other Information
Do you live within the City limits ?	Yes	No
Do you hold a public office?	Yes	No	If yes, Office held:
Are you employed by the City?	Yes	No	If yes, position:
Are you related to an employee of the City?	Yes	No	If yes, who:
Have you served on a City Board or Commission?	Yes	No	If yes, Board/Com. name: When:
Potential Conflict of Interest: Are you currently engaged in the management/ownership of any business enterprise that has a financial interest or is presently doing business with the City of Farmington? Yes No
If yes, please provide details: the information below.
City Boards/Commissions Indicate your board/commission choice below with an 'X'. If more than one, please rank by preference (1 being your first choice, 2 second choice etc..)
Administrative Review Board Cable & Communications Commission Citizen Police Advisory Committee Electrical Code Advisory Commission Lodgers' Tax Advisory Boad Oil & Gas & Geologic & Eng. Hazards Advisory Committee Planning & Zoning Commission			Airport Advisory Commission Capital Improvements Advisory Committee Community Relations Commission Library Board Metropolitan Redevelopment Agency Commission Parks, Recreation, and Cultural Affairs Commission Public Utility Commission
Qualifications (Briefly describe specific expertise, abilities, or qualifications that would be beneficial to the board.)
Education:
Qualifications:
Experience:
Other information you feel is relevant to the appointment you seek:
I understand that any false, incomplete, or misleading information given by me on the application is sufficient cause for rejection of this application. I understand and agree that any such false, incomplete, or misleading information discovered on this application at any time after appointment to a Board or Commission may result in my removal. I also understand that all Board and Commission appointments are for voluntary, uncompensated services. Additionally, if appointed, I am representing that I am able to attend regularly scheduled meetings and otherwise am able to fulfill the duties as a member of the Board or Commission. Applications are submitted to the Mayor of Farmington when vacancies occur and are effective for two years from the date of completion. Appointments to City of Farmington Boards and Commissions are made at the sole discretion of the Mayor and confirmed by the City Council; as such, this application may be utilized and referenced by the Mayor in making appointments. By submitting this application, I declare the foregoing facts to be true, correct, and complete and authorize a criminal background check should the Mayor deem it necessary. I understand that this application, when submitted to the City of Farmington, will become a public record and will be subject to review and copying by members of the public under the terms of the New Mexico Inspection of Public Records Act.
Signature			Date