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

27. 1. First Choice:*
    -- Select One --Appearance Review CommitteeBoard of AdjustmentCDBG Advisory CommitteeDevelopment Advisory CommitteeDowntown Review BoardEconomic Development CouncilHistoric Preservation CommissionHuman Relations CommissionMain Cneter Redevlopment CorporationPark CommissionPlanning CommissionPublic Art CommissionPublic Safety Citizens' Advisory BoardSolid Waste Managment CommissionTechnical Review CommitteeTIF CommissionTourism and Visitor's Advisory Commission
29. 2. Second Choice:
    -- Select One --N/AAppearance Review CommitteeBoard of AdjustmentCDBG Advisory CommitteeDevelopment Advisory CommitteeDowntown Review BoardEconomic Development CouncilHistoric Preservation CommissionHuman Relations CommissionLand BankMain Center Redevelopment CorporationPark CommissionPlanning CommissionPublic Art CommissionPublic Safety Citizens' Advisory BoardSolid Waste Management CommissionTechnical Review CommitteeTIF CommissionTourism and Visitor's Advisory Commission
31. 3. Third Choice:
    -- Select One --N/AAppearance Review CommitteeBoard of AdjustmentCDBG Advisory CommitteeDevelopment Advisory CommitteeDowntown Review BoardEconomic Development CouncilHistoric Preservation CommissionHuman Relations CommissionLand BankMain Center Redevelopment CorporationPark CommissionPlanning CommissionPublic Art CommissionPublic Safety Citizens' Advisory BoardSolid Waste Management CommissionTechnical Review CommitteeTIF CommissionTourism and Visitor's Advisory Commission
33. Please list any additional Boards or Commissions of interest:
35. If you are interested in the Public Safety Advisory Board, please list the year you graduated the Blue Springs Citizen's Police Academy.
37. My strengths for serving on the Board/Commission will be:*
39. Education*
    High School, City, State, Dates attended
41. College/University
    Institution, Degree, Dates attended
43. Post Graduate
    Institution, Degree, Dates attended
45. Current Employment*

    Current Employer, Position, Dates of Employment

47. Employment Address*
49. Past Employment
    Past Employer(s), Address, Position, Dates of Employment
51. Community Involvement*
    Organization, Position(s), Membership Date(s)
53. 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.
55. Do you have any family members that work for the City of Blue Springs; if so, state name:
57. Attachment

    An optional resume may be uploaded above.

Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit

* indicates a required field