Boards & Commissions Application

2. Current vacancies as of 9/21/2016:
   (1) Local Licensing Authority<br> (2) Elections Commission<br> (3) Library Advisory Board <br><br> ** Deadline to apply is Wednesday, October 19, 2016

   (1) Local Licensing Authority
   (2) Elections Commission
   (3) Library Advisory Board
   
   ** Deadline to apply is Wednesday, October 19, 2016

4. Boards & Commissions Application
   To apply for a board or commission vacancy, please complete this form. Submit a form for each board or commission for which you wish to apply. * Denotes a required field

   To apply for a board or commission vacancy, please complete this form. Submit a form for each board or commission for which you wish to apply. * Denotes a required field

6. Please Select Your First Choice:
   -- Select One --Airport CommissionBoard of EthicsBusiness Improvement DistrictCommunity Corrections BoardCommunity Relations CommissionDesign Review BoardElection CommissionHistoric Preservation BoardBoard of AdjustmentLibrary Advisory BoardLocal Licensing AuthorityMayor's Youth Advisory CommissionMulti-Modal Advisory BoardNatural Land Preservation Advisory BoardParks & Recreation Advisory BoardPlanning CommissionPublic Art CommissionRetirement Plan BoardUtilities Commission

8. Please Select Your Second Choice:
   -- Select One --Airport CommissionBoard of EthicsBusiness Improvement DistrictCommunity Corrections BoardCommunity Relations CommissionDesign Review BoardElection CommissionHistoric Preservation BoardBoard of AdjustmentLibrary Advisory BoardLocal Licensing AuthorityMayor's Youth Advisory CommissionMulti-Modal Advisory BoardNatural Land Preservation Advisory BoardParks & Recreation Advisory BoardPlanning CommissionPublic Art CommissionRetirement Plan BoardUtilities Commission

10. Please Select Your Third Choice:
    -- Select One --Airport CommissionBoard of EthicsBusiness Improvement DistrictCommunity Corrections BoardCommunity Relations CommissionDesign Review BoardElection CommissionHistoric Preservation BoardBoard of AdjustmentLibrary Advisory BoardLocal Licensing AuthorityMayor's Youth Advisory CommissionMulti-Modal Advisory BoardNatural Land Preservation Advisory BoardParks & Recreation Advisory BoardPlanning CommissionPublic Art CommissionRetirement Plan BoardUtilities Commission

12. First Name*

13. Last Name*

15. Home Address*

17. City*

18. State*

19. Zip*

21. Phone*

22. Email Address*

24. Is your home address located in city limits?
    1. Yes
    2. No

26. Work Address

28. City

29. State

30. Zip

32. Work Phone

33. Is your work address located in city limits?
    1. Yes
    2. No

35. Educational Experience

37. Current Occupation

39. Past Work or Volunteer Experience Pertinent to this Board or Commission

41. Why are you interested in this board or commission?

43. What do you see as the function of this board or commission?

45. Would serving on this board or commission cause any conflict of interest with your current occupation?

47. Would you represent any specific segment of the community that has an interest in the activities of this board or commission?

49. Do you do business with the City? If so, please explain...

51. Are you currently serving on any other city board or commission? (Please list all)

53. Thank you for your interest in volunteer service with the City of Durango!
    Please submit this application to the city manager's office. Your application will be kept on file for one year in case additional vacancies occur. If you have any questions or need additional information concerning this application, please call the city manager's office at (970) 375-5001.

    Please submit this application to the city manager's office. Your application will be kept on file for one year in case additional vacancies occur. If you have any questions or need additional information concerning this application, please call the city manager's office at (970) 375-5001.

54. Date

Leave This Blank:


55. 1. Receive email copy
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field