Boards and Commissions Application

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Profile

First Name *

Last Name *

Primary Phone Number *

Email *

Address Line 1 *

Address Line 2 *

City *

State *

Zip Code *

Photo *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png.

Ward *

In what ward of the City of Hopewell do you reside?

Relatives *

If you have relatives that are employed by the City of Hopewell, server on Hopewell City Council, or serve as a member of an agency in which you seek appointment, please list each relative and agency.

Application Details

Board Interest

First Choice *

Second Choice *

Third Choice *

Qualifications *

What are your specific qualifications, skills and abilities as they relate to the Board(s), Commission(s) or Committee(s) on which you have requested to serve?

Vision *

Additional Comments *

Electronic Signature *

By entering your full name in this field, you are completing an electronic signature acknowledging the below statement. By my signature hereto, I certify that (1) the information given by me in this document is correct to the best of my knowledge, (2) I understand that I may be required to provide proof of identity and, if applicable, proof of residency, and (3) I understand and agree that the city of Hopewell may make an independent investigation of my background and qualifications, including (a) under Sec. 2-61 (Criminal background check required as a condition of service to the city) of the city code, and (b) as to my references, past and present employment, education, involvement in litigation or other proceedings, and other items.