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Step One

Grand Traverse County Resident*
1. Yes
2. No
Township/City*
Registered Voter*
1. Yes
2. No
Name*
Email Address*
Address*
City*
State*
Zip Code*
Phone Number*
Phone Number
Phone Number
Is this an application for reappointment?*
1. Yes
2. No
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Board/Commission Interests

Please choose the board(s)/commission(s) for which you would like to be considered (in order of preference).
Choice 1
Choice 2
Appointments are also made to the following Boards and Committees although the frequency of meetings and/or membership is limited and consequently, so is the turnover. Application is welcomed and we will contact you if there is an opening.
1. Building Code Board of Appeals
2. Building Authority
3. Hospital Finance Authority
1. Health and Human Services Board
2. Northern Michigan Substance Abuse Council
3. Workforce Development Board
Additional choices and/or other Boards/Commissions that may not be listed above.
Brief statement regarding your interest in service on the board/commission.*
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Employment and Related Experience

Employer Name
Employer Address
City
State
Zip Code
Position Title or Nature of Work
What special skills could you bring to this position?
Education (Include degree and dates; if answered in full on your resume, please indicate)
Previous Government Appointments
Do you hold any professional licenses required for the committee on which you're interested in serving? If so, please include number or other pertinent information.
Resume or attachments (optional)
Upload a document to include a resume or supporting documentation.
Have you ever been convicted of a misdemeanor offense?
1. Yes
2. No
Have you ever been convicted of a felony offense?
1. Yes
2. No
Enter military service with years and conflict (i.e. Vietnam, Desert Storm)
Veteran's Affairs committee applicants only.
Enter year of birth.
Enter year of birth.
Commission on Aging applicants only.
I hereby certify that the information contained in this application is true and correct to the best of my knowledge. I further certify that I have personally completed this application. I understand than any misrepresentation, falsification or omission of information on this application or on any document used to secure appointment shall be grounds for rejection of this application or immediate discharge if I am appointed, regardless of the time elapsed before discovery. I further understand that all applicants selected to serve, are subject to background check including criminal history, drivers record, and Michigan Sex Offender Registry. I also understand that a background check will be run on all applications including criminal history, drivers record, and Michigan Sex Offender registry. I further understand that this application and all related information are public records subject to disclosure pursuant to the Michigan Freedom of Information Act.
I agree with and consent to all of the above.*
1. Yes
2. No
Date*
Date

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1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Board/Commission Interests

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