Application form for BHC Commission

2. Date
   Date
3. Email Address
5. Name
6. Gender
   -- Select One --MaleFemale
8. Address
10. City
11. State
12. Zip Code
14. Home Phone
15. Cell Phone
16. Work Phone
18. Application for:
    Note: If applying for Veteran's Affairs Commission, please attach you DD214 form.
20. Attach the scanned DD214 Form here
22. Please list your current place of Employment (and/or activities such as hobbies, volunteer work, etc.) that you feel may qualify you for this position:
24. The following questions will assist the Board of Supervisors in its selection; however, it is not necessary to complete the information to be eligible for consideration.
26. 1. How much time will you be able to devote to the committee/board?
28. 2. What is your reason for applying?
30. 3. List a few contributions you feel you would make to the Board/Commission you are applying for?
32. 4. What is the direction / role you perceive of the Board/Commission?
34. 5. Do you have any comments to add that may assist the Board of Supervisors in their decision?
36. 6. Attach a resume or vitae here
38. Note:
    Your application will be retained in our files for 2 years. This application is a public document and as such can be reproduced and distributed to the public.
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

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