Form Center

Application for City Advisory Boards and Commissions

2. Thank you for your interest in serving on an advisory board or commission. The purpose of this form is to provide the mayor and City Council members with some information about individuals considered for appointment. This application will be kept on file for two years. The file of completed applications is open for public inspection upon request.

   Thank you for your interest in serving on an advisory board or commission. The purpose of this form is to provide the mayor and City Council members with some information about individuals considered for appointment. This application will be kept on file for two years. The file of completed applications is open for public inspection upon request.

6. Date
   Date

   Date

7. City of Liberty Lake advisory board or commission for which you are applying:
   -- Select One --City Planning CommissionCommunity Development SubcommitteeDesign Review CommitteeLibrary Board of TrusteesParks and Arts Commission

8. Would your appointment create a conflict of interest or appearance thereof?
   -- Select One --YesNo

12. First Name

13. Last Name

15. Address1

17. Address2

19. City

20. State

21. Zip

23. Home Phone

24. Fax

26. Work Phone

27. Email

31. Employer

33. Business Address

35. Address2

37. City

38. State

39. Zip

43. Are you a registered voter in the City of Liberty Lake?
    -- Select One --YesNo

44. How long have you lived in the City of Liberty Lake (continuously)?
    -- Select One --Less than 1 year1-2 years3-4 years5-6 yearsOver 6 years

48. Educational Background

50. Professional Qualifications / Work Experience

52. Community Activities / Involvement Experience

54. Other Qualifications / Reasons for Desire to Serve

58. Reference #1 Name

59. Reference #1 Phone

61. Address1

63. Address2

65. City

66. State

67. Zip

71. Reference #2 Name

72. Reference #2 Phone

74. Address1

76. Address2

78. City

79. State

80. Zip

84. Reference #3 Name

85. Reference #3 Phone

87. Address1

89. Address2

91. City

92. State

93. Zip

Leave This Blank:


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

    This field is not part of the form submission.

97. Submit Submit and Print

* indicates a required field