Form Center

2. Name
3. Date
5. Residence Address
6. Mailing Address

   If different then residence address.

   
   

8. Phone
9. Email
11. Employer
12. Employer Address
14. Occupation/Title
16. To which board/commission are you applying?

    1. Asset Management Commission
    2. Board of Assessment Review
    3. Board of Canvassers
    4. Budget Committee
    5. Charter Review Committee
    6. Conservation Commission
    7. Economic Development Commission
    8. Groundwater Protection Committee
    9. Halliwell Multi-Generational Building Committee
    10. Historic District Commission
    11. Juvenile Hearing Board
    12. Parks & Recreation Commission
    13. Personnel Board
    14. Planning Board
    15. Public Arts Advisory Committee
    16. Public Safety Commission
    17. Senior Citizen Advisory Committee
    18. Sewer Commission
    19. Zoning Board of Review
    20. Other
18. If you are not appointed to this board/commission, please indicate any other board/commission (s) for which you are willing to be considered:
20. Town charter provisions require that all regular and alternate members of boards and commissions shall be qualified electors of the town of north smithfield. Are you a north smithfield resident?

    1. Yes
    2. No
21. Have you been asked by a board/commission to become a member?

    1. Yes
    2. No
23. How did you hear about this board/commission?
25. Why are you seeking an appointment with this board/commission?
27. What is your experience or knowledge regarding the duties of this board/commission?
29. Please list any education, experience, professional achievement, previous occupation, skills, or special interests you may have that will assist you with this board/committee to which you would like to be appointed?
31. How many times have you attended a meeting of the board/committee to which you would like to be appointed?
33. Would there be a possible conflict of interest if you were appointed to this board/committee?

    1. Yes
    2. No
34. Have you ever had business before the board/committee to which you are requesting an appointment?

    1. Yes
    2. No
36. Please list all other board/committees on which you have served in this or other towns:

38. Please read Code of Conduct Policy. Acknowledge/accept with signature below

41. Optional: if you have a resume, references or any other documentation that would assist in the selection process, please email a copy to jbuttie@nsmithfieldri.gov
43. Submission of the form in no way assures an appointment. All board/commission vacancies shall be filled by town residence that are deemed the most qualified to serve in a particular capacity:
45. Applicant signature: I understand that by typing my name and clicking on "submit", I am electronically signing this document.
47. Date
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field