Application for Board or Committee

Application for Appointment / Re-Appointment to a Board/Committee for the City of Lowell, NC
The City of Lowell appreciates your interest in serving on a Board/Committee and requests that you complete the following application. This application requests general information based on your interest in applying for a Board/Committee for the City of Lowell.
Applicant Name * Required
Date of Application * Required
MM slash DD slash YYYY
Do you reside or own a business within the City Limits of Lowell? * Required
- Yes
- No
Length of residence in Lowell (i.e. __ years, __months)
Home Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Mailing Address (if different from above)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Cell Phone (for City Hall use only)
Home Phone
Business Phone
Email Address
In order to consider this application and provide balance and diversity to the various Boards/Committees, the City of Lowell requests that the following information be voluntarily provided:
Age
Gender
- Male
- Female
Occupation
Committee or Board Preference
Which committees/boards are you interested in serving on? * Required
- Lowell Community Committee
- Planning and Zoning Board
Planning and Zoning Board also serves as the Board of Adjustments and the Stormwater Commission. The Board of Adjustments and Stormwater Commission meet as needed directly after the Planning Board meetings.
Board/Committee Preference
If you prefer to serve on one board over the other, please specify which board/committee you would prefer.
Questionnaire
Why do you want to serve or continue to serve on this board/committee? * Required
Why do you think you would be an asset to this board/committee? * Required
What do you feel are your qualifications for serving on the board/committee requested? * Required
Prior Public Service

Board/Committee/Civic
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Prior Public Service

Board/Committee/Civic
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Additional Comments
Ethics Guidelines * Required
I agree to the Ethics Guidelines for City Committees/Boards.
If appointed or re-appointed, I pledge to comply with the following ethics guidelines for boards as adopted by the City of Lowell.

Members of boards shall not discuss, advocate, or vote on any matters in which they have a conflict of interest or an interest which reasonably might appear to be in conflict with the concept of fairness in dealing with public business. A conflict of interest or potential conflict occurs if a member has a separate, private, or monetary interest, either direct or indirect, in any issue or transaction under consideration. Any member who violates this provision may be subject to removal from the board.

If the board believes he/she has conflict of interest, then the member should ask the board to be excused from voting. The board should then vote on the question on whether or not the excuse the member making the request. In cases where the individual member or the board establishes a conflict of interest, then the board member shall remove themselves from the voting area.
Date * Required
MM slash DD slash YYYY
Criminal Background Check * Required
I understand that a criminal background check will be conducted on new committee members and reappointed members.

Application for Board or Committee

Application for Appointment / Re-Appointment to a Board/Committee for the City of Lowell, NC

In order to consider this application and provide balance and diversity to the various Boards/Committees, the City of Lowell requests that the following information be voluntarily provided:

Committee or Board Preference

Questionnaire