Nelson County Government: County Boards and Commissions Application Form

County Boards and Commissions Application Form

NELSON COUNTY BOARD OF SUPERVISORS

Subject: Appointments - Statement of Interest Form

Completing this form is one way to indicate your interest in being considered for appointment to some of the Boards, Commissions and Committees appointed by the Board of Supervisors. All appointments remain at the discretion of the Board of Supervisors. Please complete and mail this form to: Nelson County Board of Supervisors, Attention: Stephen A. Carter, Clerk of Board, Post Office Box 336, Lovingston, VA   22949 or fax to (434) 263-7004.
                                                                                       Date _______________

Mr. ____
Mrs. ____   Name: ____________________________
Ms. ____

List a maximum of three (3) Boards on which you are interested in serving.
1.   _______________________________________
2.   _______________________________________
3.   _______________________________________

Home Address: ______________________________________________________________________________________

Occupation: ________________________   Employed by: ______________________

Home Phone No.: ____________________ Business Phone No.:_________________

Fax No.: ____________________________ E-Mail Address: ___________________

Do you live in Nelson County? Yes ___   No ___

Are you currently a member of a County Board, Commission, Committee or Authority?   Yes ___ No ___

If yes, list the Board(s): __________________________________________________________________

What talent(s) and/or experience can you bring to the Board(s)?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
What do you feel you can contribute to the Board(s) and to the community that may not be evident from information already on this form?
___________________________________________________________________________
___________________________________________________________________________

Please use this space for any additional information you would like to provide:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

A resume or separate sheet with additional information may be included.

Attendance requirements: Section 2-153, Absences, Chapter 2, Administration, Article V. Appointments for Boards and Commissions of the Nelson County Code, an appointee of the Board of Supervisors who either (a) fails, during a calendar year, to attend seventy-five percent of the regular meetings of the board or commission of which he/she is a member, or (b) is absent for three consecutive regular meetings, shall be deemed to have tendered his/her resignation from such position. The Board of Supervisors may accept such resignation by appointing another person to fill the position.

In light of the above, will you be able to attend at least 75% of the regular meetings of the boards to which you may be appointed?
Yes ___ No ___