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2. Members of City Boards and Commissions shall receive no compensation for the performance of their duties.

   Former City Employees will not be eligible for appointment to a City Board until two years after their separation from City employment.

4. First Name*
5. Last Name*
6. Preferred Name
8. Home/Residential Address*

   Your home/residential/physical address

10. City Council District*
    -- Select One --123Not a resident
11. Please visit the City's interactive online map to determine your City Council District
    City Council District Map
13. Email*
14. Primary Phone*
15. Secondary Phone
17. Race/Ethnicity*
    -- Select One --Hispanic or LatinoWhite (Not Hispanic or Latino)Black or African American (Not Hispanic or Latino)Native Hawaiian or Pacific Islander (Not Hispanic or Latino)Asian (Not Hispanic or Latino)Native American or Alaska Native (Not Hispanic or Latino)Two or more races (Not Hispanic or Latino)Prefer not to disclose
18. Gender*
    -- Select One --MaleFemaleNon-binaryPrefer not to disclose
20. Generation Range*
    -- Select One --30 or Younger31 - 4142 - 5253 - 6364 or OlderPrefer not to disclose
21. Affinity Group Affiliation (N/A if none)*
23. Click Here for a description of each Board and Commission and their function
25. 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. Land Bank
    10. Main Center Redevelopment Corporation
    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
    18. Tourism and Visitor's Advisory Commission
27. Please list your top three Boards and Commission selections in order of preference: *
29. If you are interested in the Public Safety Advisory Board, please list the year you graduated the Blue Springs Citizen's Police Academy.
31. My strengths for serving on the Board/Commission will be:*
33. Education*
    High School, City, State, Dates attended
35. College/University
    Institution, Degree, Dates attended
37. Post Graduate
    Institution, Degree, Dates attended
39. Current Employment*

    Current Employer, Position, Dates of Employment

41. Employment Address*
43. Past Employment
    Past Employer(s), Address, Position, Dates of Employment
45. Community Involvement*
    Organization, Position(s), Membership Date(s)
47. 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.
49. Do you have any family members that work for the City of Blue Springs; if so, state name:
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit

* indicates a required field