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Agenda - 01-31-2012 - 4
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Agenda - 01-31-2012 - 4
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8/3/2012 10:01:43 AM
Creation date
1/27/2012 12:33:59 PM
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BOCC
Date
1/31/2012
Meeting Type
Work Session
Document Type
Agenda
Agenda Item
4
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Minutes 01-31-2012
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\Board of County Commissioners\Minutes - Approved\2010's\2012
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NEW HANOVER COUNTY <br />BOARD OF COMMISSIONERS <br />230 Government Center Drive, Suite 175 <br />Wilmington, NC 28403 COMMITTEE APPLICATION <br />Telephone (910) 798-7149 <br />FAX (910) 798-7145 <br />Board/Committee: <br />Name: <br />E-Mail: <br />23 <br />~~ <br />~~' <br />~=1 <br />Home <br />Address: <br />reet y ~p o e <br />Mailing Address if different: <br />Home Phone: <br />(City) <br />(Zip Code) <br />Fax: Cell: Business: <br />Years living in <br />New Hanover County: Male: Female: Race: Age: <br />(Information for the purpose ofassuring across-section of the community) <br />Do you have a family member employed by New Hanover County? ff yes, name <br />Employer. <br />A person currently employed by the agency or department for which this application is made, must resign his/her position with New Hanover County upon appointment in <br />accordance with Artide Vl, Sec. 4 of the New Hanover County Personnel Policy. Furthemrore, applicant should have no immediate family member employed by such agency or <br />department. <br />Occupation: <br />Professional Activities: <br />Volunteer Activities; <br />Why do you wish to serve on this board/committee? <br />Conflict of Interest: ff a board member believes he/she has a conflict or potential conflict of interest on a particularissue, that member should state this belief to the other <br />members of his/her respective board during a public meeting. The member should state the nature of the conflict detailing that he/she has a separate, private, or monetary <br />interest either direct or indirect, in the issue under consideration. The member should then excuse himself/herself from voting on the matter. <br />What areas of concern would you like to see addressed by this committee? <br />Qualifications for serving: <br />Other municipal or county boards/committees on which you are serving: <br />List three local personal references and phone numbers: <br />1. <br />2. <br />3. <br />Date: <br />Applications are kept on file for 18 months <br />Please use reverse side for additional comments <br />Signature <br />I understand that any board or committee appointee maybe removed <br />without cause by a majority of County Commissioners. <br />
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