Wayne County Advisory Boards and Commissions

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APPLICATION FOR APPOINTMENT TO
WAYNE COUNTY ADVISORY BOARDS AND COMMISSIONS

The Wayne County Board of Commissioners believes all citizens should have the opportunity to participate in governmental decisions. One way of participating is by serving as a citizen member on one of the county's advisory boards. If you want to be considered for appointment to an advisory board, please complete the on-line form below.

* Indicates a required field

Advisory Board/Committee/Commission interested in:

*1st Choice

2nd Choice

3rd Choice

Contact/Personal Information:

*Name
*Address
*City/State/Zip
*Township
Home Phone
Business/Work Phone
Wayne County Resident	Yes, I am a Wayne County resident.
Age (Optional)
E-mail
Occupation
Business/Employer Name
Address
City/State/Zip
Position
Educational Background
Business and Civic Experience and Skills
Other Boards, Committees, or Commissions Presently Serving On and the Expiration Dates

References:
List three people who are not related to you and who have definite knowledge of your qualifications and fitness for the position for which you are applying.

Name
Address
City/State/Zip
Phone
Business/Occupation

Name
Address
City/State/Zip
Phone
Business/Occupation

Name
Address
City/State/Zip
Phone
Business/Occupation

I understand this application will be kept on the active file for two years and I hereby authorize Wayne County to verify all information included in this application.

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