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For questions regarding this form, contact the City Clerk at 703-248-5014 (TTY 711) or firstname.lastname@example.org.
Check the boxes below to indicate you have read, understand, and/or satisfied the qualifications for submitting an application to serve as a city board or commission member.
Please note that applications will not be accepted unless all qualifications are met, including attending at least one meeting of the board or commission to which you are applying. ***
Do not submit this application until you have satisfied all of the requirements.
If applying for Retirement Board, City Employee Review Board, or Towing Advisory Board, this requirement may not apply. Contact City Clerk for details, 703-248-5014 or email@example.com. If you have confirmed that this requirement does not apply, please check meeting attendance box.
Your application will not be accepted unless you have satisfied this requirement as described above. If you are applying for one of the exempt positions, enter "N/A."
The information contained in this application may be made available to the public in response to a request made pursuant to the Virginia Freedom of Information Act, Virginia Code Section 2.1-342.01(4). By submitting this application, the applicant waives any claim of privacy to this application and any documents submitted in connection with the application.
Pursuant to Virginia Code Title 58.1-11, it is a Class 1 misdemeanor for any person to intentionally submit an application that he does not believe to be true and correct as to every material matter.
By checking "I Agree," you agree and acknowledge your electronic signature is valid and binding in the same force and effect as a handwritten signature.
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