|
APPLICATION (PLEASE PRINT)
|
NAME:
___________________________________________________________________________
Last, First, Middle Initial
ADDRESS:
___________________________________________________________________________
Street, City or Town, State, Zip Code
PHONE:
home: __________________________ work: __________________________
MAILING ADDRESS:
___________________________________________________________________________
If different from above
1. Please list the Board, Committee or Commission(s) you would be interested in serving on:
2. What expertise, if any, would you bring to the above listed Board, Committee or Commission(s)?
3. Please list Job Experience:
4. Please list Educational Background:
5. Please give detailed statement of interest:
6. Do you anticipate having to refrain from participating in discussion and voting on any particular matter(s) that may come before said Board, Committee or Commission(s) because of a conflict of interest? If so, please explain:
7. Please give the date you last came to reside in South Kingstown:
8. Please be advised that appointment to Zoning Board and Planning Board and several of our other Boards require time during the regular work day to review plans and conduct site inspections. Do you understand the time requirements necessary to serve and are you able to make that commitment?
9. I have received copies of and understand the following from the Rhode Island Ethics Commission: "HOW TO GET AN ADVISORY OPINION", "COMPLAINTS, INVESTIGATIONS AND ENFORCEMENT", "FINANCIAL DISCLOSURE REQUIREMENTS", "HOW TO RECUSE", "A GUIDE TO THE CODE OF ETHICS for PUBLIC OFFICIALS & EMPLOYEES", YEARLY FINANCIAL STATEMENT; and a recusal form.
SIGNATURE:
___________________________________________________________________________
Name and Date
SHOULD YOU REQUIRE ANY ADDITIONAL SPACE TO COMPLETE ANY OF THE ABOVE QUESTIONS, PLEASE ATTACH AN ADDITIONAL SHEET.
|
|
|
|
