Date. **This application will be held on file for 1 year***. Please return application to: Amy Atkins, Clerk to the Boar
Print Form
VOLUNTEER APPLICATION FOR APPOINTMENT TO LINCOLN COUNTY BOARDS, COMMITTEES, AND COMMISSIONS (Use reverse side or attachments if additional space is required) Name: ____________________________________________________________ Address: ___________________________________________________________ Telephone: (w) ________________________(h) ___________________________ Fax: _____________________________ Email: ___________________________ Township of Residence: __________________________________________ In order to comply with State reporting requirements, please complete the following questions: Sex: __________________________ Race: _______________________ Date of Birth: ____________________ Please list in order of preference the Boards, Committees, and Commissions for which you would like to serve: 1._________________________________ 3._______________________________ 2._________________________________ 4._______________________________ Presently employed by: __________________________________________________ Job title: ______________________________________________________________ Duties performed: ______________________________________________________ Employment history______________________________________________________ Education ______________________________________________________________ Volunteer activities ______________________________________________________ Areas of expertise, interest, skills ___________________________________________ Please state the reasons you feel qualified for this appointment _______________________________________________________________________ County Boards/Committees/Commissions currently serving on or previously served on: ______________________________________________________________________
_______________________________ Signature
__________________________ Date
**This application will be held on file for 1 year*** Please return application to: Amy Atkins, Clerk to the Board, 115 W. Main Street, Lincolnton, NC 28092 (704) 736-8473 Fax (704) 736-8820 email –
[email protected] 