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Town of Danville, Indiana

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Application to Serve on Board or Commission

About this Form

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Town of Danville Board and Commission Application

Instructions

1. Complete the application

2. Submit a resume to the Town Manager at mmorgan@danvilleIN.gov

* Applications are a matter of public record and are available for public review upon appointment recommendation.

* Denotes a required field

Date:

MonthDay Year,

First Name

Last Name

Address

City

State

ZIP

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

Home/Cell:

Home/Cell: Area Code-Home/Cell: Prefix-Home/Cell: Line Number ext Home/Cell: Extension

Please Do Not Complete The Following Field

Work Phone:

Work Phone: Area Code-Work Phone: Prefix-Work Phone: Line Number ext Work Phone: Extension

Email:

How did you learn of this vacancy?

Please select appointment of interest:

How long have you been a Danville Resident?

To serve on a Town Board or Commission, you must reside within the town limits—except for the Center Township/Danville Public Library Board, where residency in Center Township is required.

Work History

Check all applicable:

Retired

Employed

Unemployed

Military

Company/City, State

Job Title:

Duty Summary:

List relevant history supporting favorable appointment.

Community Activities

If you have been a member of a Town Board, Commission, or Committee, please list below:

Committee name:

Dates:

MonthDay Year,

Committee name:

Dates:

MonthDay Year,

Please list current and past civic, fraternal, volunteer, and non-profit organizations in which you are or have been active:

Organization name:

Dates:

MonthDay Year,

Organization name:

Dates:

MonthDay Year,

Appointment Interest

Please email additional attachments and resume to mmorgan@danvilleIN.gov:

Please provide a brief statement indicating why you wish to serve on this board or commission and what you believe you can contribute:

What specific objectives would you be working towards as a member of this board or commission:

Summarize your qualifications for appointment; include education, training, experience, licenses, etc.:

Certification

By checking the box I hereby certify: * All information in this application is complete, truthful, and accurate to the best of my knowledge. * If appointed, I understand it is my responsibility to notify the Town of changes that would affect my membership on the board, commission, or committee. * I recognize that the Board/Commission/Committee membership requires my attendance at meetings and/or events. I am willing and able to make this commitment of time and effort to serve. * I understand that this application becomes part of the Town's public records and may be disclosed upon request. If appointed, I understand that I may be required to file a conflict of interest statement.

Check Box:

I hereby certify

If applying for Park Board, Planning Commission, Police Merit Board, or Fire Merit Board, you must declare your party affiliation.

My declared Party is:

Signature:

The Town of Danville Recognizes the State of Indiana Attorney General's Guideline for "Dual Office Holding or Dual Lucrative Board Appointments." All applicants are encouraged to go to the State of Indiana's website and review their eligibility to serve on one or more Boards for the Town of Danville. https://www.in.gov/attorneygeneral/files/2022-Dual-Office-Holding-Guide.pdf

Applications MUST be submitted before the established filing deadline. Email resumes to the Town Manager Mark Morgan at mmorgan@danvilleIN.gov or drop them off at Town Hall. Town Hall 49 N. Wayne St. Danville, IN 46122