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2. PERSONAL INFORMATION
4. Name*
5. Email Address*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
15. Date of Birth*
    Date of Birth

    Date Of Birth is necessary to conduct the criminal background check

17. Please check the appropriate response:*

    1. City Resident

    1. Non-Resident/City Property Owner

    1. Non-City Resident
19. PLEASE LIST YOUR SCHEDULE AVAILABILITY

    Please select days & times.

21. Days available*

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
    7. Sunday
22. Times Available*

    1. Morning (8am-12pm)
    2. Afternoon (12-5pm)
    3. Evening (After 5pm)
24. Please mark the area(s) of interest that are relevant to you:

    1. Parks Beautification Projects (DeGraaf Nature Center Trail Guides and Clean up, etc.)
    2. Elections
    3. National Night Out (1st Tuesday in August)
    4. Neighborhood Watch
    5. Downtown Events
    6. Farmer's Market Events
    7. Office Assistance
26. Have you ever been convicted of a felony?*

    1. Yes
    2. No
28. Please explain:
30. 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.
32. Electronic Signature*
33. Today's Date*
    Today's Date
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field