Date Submitted: 05/12/2012

City of Lewisville Application for Boards, Commissions and Committees

The Lewisville City Council currently makes appointments to ten City boards, commissions and committees. Appointments are considered by the Council prior to June 30 of each year for expiring terms of office.

In addition to these standing appointments, the Council may, from time to time, appoint individuals to fill interim terms created by current members who can no longer serve, and appoint special study committees.

If you are interested in serving on a board, commission or committee, complete this form and submit it to the City Secretary’s Office. These data sheets forms are submitted to the Council prior to upcoming appointments and as vacancies occur during the year, and are retained by the City Secretary for a period of one year.

Indicate top five preferences:

Qualifications: Applicants must have resided in the City of Lewisville for a year and be a registered voter.
    First Preference:
    Second Preference:
    Third Preference:
    Fourth Preference:
    Fifth Preference:

Ms.
Mrs.
Mr.

Email Address:
First Name:
Last Name:
Home Address:

Lewisville, TX
Lewisville Resident for: Years
Months
Home Phone: - -
Business Address:

City:
State: Zip:
Business Phone: - - Ext.:
Occupation:
Voter Registration Number:
Education:
Special Knowledge or Experience Applicable to the Position(s) Indicated:
Other Information (Civic/Community Activities, etc.):
I have attended one or more meetings of the board, commission or committee for which I have applied.
Yes
No
How would you like to be interviewed?
by telephone
in person

By signing this document I authorize the City’s employee or agent supervising this activity to secure medical care for me in the event of injury. I promise to assume liability for payment, and hold harmless the City, its officers, employees, sponsors, volunteers, or agents, of medical expenses arising from said medical care for said injury.

Call (972) 219-3413 or you may send email to jheinze@cityoflewisville.com for more information.