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2. Board or Commission Applying For
4. Name
5. Email Address
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Fax Number
16. Are you a registered voter of Whitefish Bay?
17. How long?
19. Have you attended a meeting of this Board/Commission?
21. Present Employer
22. Job Title
24. Previous Governmental Bodies/Elective Offices Applicant Has Served
26. Position/Office Held
27. Dates
29. Civic or Charitable Organizations to Which Applicant Has Belonged
31. Position Held
32. Dates
34. Special Interests/Hobbies/Talents
36. College, Professional, Vocational Schools Attended
38. Major Subject
39. Dates
    Dates Start Date

    —

    Dates End Date
40. Degree/Date
42. College, Professional, Vocational Schools Attended
44. Major Subject
45. Dates
    Dates Start Date

    —

    Dates End Date
46. Degree/Date
48. College, Professional, Vocational Schools Attended
50. Major Subject
51. Dates
    Dates Start Date

    —

    Dates End Date
52. Degree/Date
54. Please state reasons why you want to become a member of this Board or Commission, including what specific objectives you would be working toward as a member of this advisory board: (Attach second page if necessary)
56. Any other information which you feel would be useful to the Board of Trustees in reviewing your application: (Attach 2nd page if necessary)
58. Are you or a member of your family associated with any Organization/Employment that might be deemed a conflict of interest in performing your duties if appointed to this position?

    1. Yes

    1. No
59. If yes, please state name of Organization/Employment
61. Do you have any relatives working or serving for the Village of Whitefish Bay?

    1. Yes

    1. No
62. If yes, please indicate the name and relationship of the person
64. Would you be willing to abstain from voting on matters where a potential conflict of interest exists?

    1. Yes

    1. No
66. Have you been convicted of a felony or misdemeanor?

    1. Yes

    1. No
67. If yes, explain convictions
    Do not list any misdemeanor settled in juvenile court.
69. How did you hear about the opening on this Commission?
71. Signature of Applicant
    By typing your name into this field you authorize the Village to consider this an electronic signature.
72. Date
    Date
Leave This Blank:


74. 1. Receive an email copy of this form.
75. Email address

    This field is not part of the form submission.

76. Submit

* indicates a required field