Volunteer Board Member Application

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First Name *

Last Name *

Address *

Home Phone Number *

Mobile Phone Number *

Email *

Resident of the Town of Hickory Creek for (months): * months

(Must have resided in the state for twelve (12) months and in the town for six (6) months.)

Voter Registration Number *

Occupation

Education

Please number your preference for board and commission membership on a scale of 1 to 5 with 1 being your first choice. *

	1	2	3	4	5
Arts and Culture Board *	Arts and Culture Board - 1	Arts and Culture Board - 2	Arts and Culture Board - 3	Arts and Culture Board - 4	Arts and Culture Board - 5
Board of Adjustments *	Board of Adjustments - 1	Board of Adjustments - 2	Board of Adjustments - 3	Board of Adjustments - 4	Board of Adjustments - 5
Economic Development Corporation *	Economic Development Corporation - 1	Economic Development Corporation - 2	Economic Development Corporation - 3	Economic Development Corporation - 4	Economic Development Corporation - 5
Parks and Recreation Board *	Parks and Recreation Board - 1	Parks and Recreation Board - 2	Parks and Recreation Board - 3	Parks and Recreation Board - 4	Parks and Recreation Board - 5
Planning and Zoning Commission *	Planning and Zoning Commission - 1	Planning and Zoning Commission - 2	Planning and Zoning Commission - 3	Planning and Zoning Commission - 4	Planning and Zoning Commission - 5

Special Knowledge or Experience Applicable to Board/Commission/Committee Function

Other information (Civic Activities, etc)

Electronic Signature Agreement *

I understand that by signing this application I am granting the Town of Hickory Creek, through its officers, agents and administrative staff, permission to conduct a third party background check. A link will be sent to your email address to complete an E-Release. Applications are retained on file for 12 months.

I agree.

Electronic Signature *

Receive an email copy of this form *

Receive an email copy of this form.

Email address *

This field is not part of the form submission.