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Application to Serve on a Board/Commission

Step 1 of 1

Complete this application to serve on a variety of Town of Lowell Boards and Commissions.

* Denotes a required field

Date*

MonthDay Year,

Board/Commission Position Desired*

Your Information

Full Name*

Address*

City*

State*

ZIP*

Zip-Zip +4
Second portion of ZIP Code is optional.

Email Address*

Phone Number*

Phone Area Code-Phone 3-Phone 4 ext Extension

Please Do Not Complete The Following Field

Are you a U.S. Citizen?

Yes

How many years have you lived in Lowell?*

What is your Political Affiliation? (Required for some positions)*

Have you ever been convicted of a felony?*

Yes

If yes, please state the offense(s) for which you were convicted and give date(s) of conviction(s) and the court in which the conviction(s) was rendered.

List names, addresses and telephone numbers of 3 references not related to you.*

Education

High School (name and location)

Years Completed

Business/Vocational (name and location)

Years Completed

College/Technical (name and location)

Years Completed

Graduate/Professional (name and location)

Years completed

Employment History

Present Employer

Address

City

State

ZIP

Zip-Zip +4
Second portion of ZIP Code is optional.

Business Phone

Phone Area Code-Phone 3-Phone 4 ext Extension

Employed from (month & year)

Employed to (month & year)

Title of Position

Kind of Business Organization

Your Duties and Responsibilities

Previous Positions of Employment (List Company/Organization, City/State, and Dates of Employment)

Civic Activities (offices held, honors, etc.)

Additional information you wish to include

By checking this box, I certify that this form is true and accurate to the best of my knowledge.*

I agree

Application to Serve on a Board/Commission

Your Information

Education

Employment History

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