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2. Applying For:*
   -- Select One --Audit Committee – No residency requirementBoard of AppealsBoard of ReviewBrownfield Redevelopment Authority – No residency requirementBuilding Authority – No residency requirementCivic Center Board - No residency requirementCommunity Energy Plan Steering Committee – No residency requirementCommunity Energy Plan Strategic Development Team – No residency requirementCompensation CommitteeDangerous StructuresDowntown Design Review Board – No residency requirementDowntown Development Authority Board – No residency requirementDowntown Parking Board – No residency requirementFarmers Market Advisory Board – No residency requirementHistoric District CommissionHolland Youth Advisory Council – No residency requirementHuman Relations CommissionInternational Relations Commission – No residency requirementNeighborhood Improvement CommitteeParks and Recreation Commission – No residency requirementPlanning CommissionPolice-Community Relations Commission – No residency requirementPrincipal Shopping District Board (Business/Merchant on Downtown Area) – No residency requirementPublic Art Advisory Committee – No residency requirementSouth Shore Village Business Improvement District (District Property and Business Owners)Teen Court Advisory Board – No residency requirementWashington Square Business Improvement District (District Property and Business Owners)
6. PERSONAL INFORMATION
8. First*
9. Last Name*
11. Address*
13. City*
14. State*
15. Zip Code*
17. Phone Number*
18. Email Address*
19. Date Of Birth*
    Date Of Birth

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

21. Please check the appropriate response*

    1. City Resident

    1. Non-Resident/City Property Owner

    1. Non-City Resident
25. EDUCATION
27. Do you have a high school diploma or high school equivalency (i.e. GED)? *

    1. Yes

    1. No
29. Do you have an undergraduate degree from a college or university?*

    1. Yes

    1. No
31. Do you have a graduate degree from a college or university?*

    1. Yes

    1. No
33. EMPLOYMENT HISTORY*

    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)

37. EXPERIENCE
39. Have you ever attended a meeting of the board, commission, or committee for which you are applying?*

    1. Yes

    1. No
41. Please briefly describe your understanding of the responsibilities of the board, commission, or committee for which you are applying*
43. What particular talents or skills would you bring to the board, commission, or committee for which you are applying?*
45. Please describe your involvement in, or affiliation with, any professional associations*
49. MISCELLANEOUS
51. Did you review the typical meeting times for the BCC for which you are applying?*

    1. Yes

    1. No
53. Are you able to attend meeting during these hours?*

    1. Yes

    1. No
55. Why do you wish to be a member of the board, commission, or committee for which you are applying?*
57. Have you ever been convicted of a felony?*

    1. Yes

    1. No
59. If yes, please explain:

61. 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 hcmanager@cityofholland.com with any special needs or accommodations.

65. ACKNOWLEDGEMENT

    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.

69. CERTIFICATION/SIGNATURE

    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.

71. 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.

    1. I agree.
73. Electronic Signature*
74. Today's Date*
    Today's Date
Leave This Blank:


76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit

* indicates a required field