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Application for Boards, Commissions, and Committees

  2. Date of Birth is necessary to conduct the criminal background check.

  3. Please check the appropriate response*
  5. Do you have a high school diploma or high school equivalency (i.e. GED)? *
  6. Do you have an undergraduate degree from a college or university?*
  7. Do you have a graduate degree from a college or university?*
  8. Please provide a brief summary of your employment history for the last 10 years, beginning with your current or most recent employer:  If retired, please indicate previous employment. Be sure to include Occupation, Employer and Dates of Employment(Month/Year)

  10. Have you ever attended a meeting of the board, commission, or committee for which you are applying?*
  12. Did you review the typical meeting times for the BCC for which you are applying?*
  13. Are you able to attend meeting during these hours?*
  14. Have you ever been convicted of a felony?*
  15. The City of Holland is committed to the implementation of the Americans with Disabilities Act. Please contact the City Manager’s Office via email at with any special needs or accommodations.


    Because serving on a board, commission or committee requires a substantial commitment of time, effort, and scheduling on the part of the members, we ask that you carefully consider your schedule before pursuing appointment to a board, commission, or committee and that by signing below you are confirming your willingness to make a concerted effort to attend every meeting and to fulfill your duties and responsibilities as a member. All information submitted in this application is public information and subject to disclosure in response to a public records request made pursuant to the Freedom of Information Act.


    I certify that all statements on this Board, Commission, or Committee application are made truthfully and without evasion, and further understand and agree that such statements may be investigated and, if found to be false, will be sufficient reason for not being appointed.

    I understand that a criminal background check must be completed and passed before being accepted as volunteer and that said information will be kept confidential.

    The information on this application will be treated in a confidential manner by the City of Holland. However, appropriate information will be reviewed by the City Council prior to an appointment being approved.

  18. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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  20. This field is not part of the form submission.