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Boards and Commissions Application

2. First Name*

3. Last Name*

5. Home/Residential Address*

   Your home/residential/physical address

7. City*

8. State*

9. Zip*

11. Business/Mailing Address

13. City

14. State

15. Zip

17. Email*

18. Cell Phone*

19. Home Phone

21. click here for a description of each Board and Commission and their function

23. I want to apply to serve on the following Boards and Commissions:*

    1. Appearance Review Committee
    2. Board of Adjustment
    3. CDBG Advisory Committee
    4. Development Advisory Committee
    5. Downtown Review Board
    6. Economic Development Council
    7. Historic Preservation Commission
    8. Human Relations Commission
    9. Industrial Development Authority
    10. Land Bank
    11. Park Commission
    12. Planning Commission
    13. Public Art Commission
    14. Public Safety Citizens' Advisory Board * Must be a graduate of the Citizen's Police Academy
    15. Solid Waste Management Commission
    16. Technical Review Committee
    17. TIF Commission

25. Please list your top three Boards and Commission selections in order of preference: *

27. If you are interested in the Public Safety Advisory Board, please list the year you graduated the Blue Springs Citizen's Police Academy.

29. My strenghts for serving on the Board/Commission will be:*

31. Education*

    High School, City, State, Dates attended

33. College/University

    Institution, Degree, Dates attended

35. Post Graduate

    Institution, Degree, Dates attended

37. Current Employment*

    Current Employer, Address, Position, Dates of Employment

39. Past Employment

    Past Employer(s), Address, Position, Dates of Employment

41. Community Involvement*

    Organization, Position(s), Membership Date(s)

43. Conflict of Interests*

    Do you have business or property interests that might place you in a conflict of interest situation should you be appointed to this Board/Commission? If so, please explain.

Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field