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2. First Name*
3. Last Name*
5. Home Address*
7. City*
8. State*
9. Zip Code*
11. Mailing Address (If Different)
13. City
14. State
15. Zip Code
17. Phone*
18. Email*
20. Which Board, Commission or Committee are you applying for?*

    1. Board of Assessors
    2. Board of Registrars
    3. Cable Advisory Committee
    4. Cemetery Advisory Committee
    5. Conservation Commission
    6. Council on Aging
    7. Cultural Council
    8. Design Review
    9. Energy Committee
    10. Health Care Trust Commission
    11. Historical Commission

    1. Housing Trust
    2. Lakes & Waterways
    3. Liquor License Commission
    4. Master Plan Implementation Committee
    5. Open Space, Natural Resources and Trails Committee
    6. Parks and Recreation Committee
    7. Traffic and Transportation Committee
    8. Trustees of War Memorials
    9. Zoning Board of Appeals
    10. Other
22. If other, please specify:
24. Please explain why you would like to serve on a particular Board, Commission or Committee:*
26. Please briefly describe your education and any relevant work or life experience or other activity which, in your opinion, would be beneficial in carrying out the responsibilities of this office. If necessary, attach additional sheets or your resume.*
28. Please list any City offices you have held in Amesbury or elsewhere. Please share the name of the Office held, the date you were appointed or elected, and the date when your term expired.*
30. Public service on a Board, Committee, or Commission can be demanding. Please indicate the realistic time commitment you are willing and able to make:*

    1. 1 hour per week
    2. 2 to 4 hours per week
    3. 4 to 6 hours per week
    4. 6+ hours per week
32. Additionally, please describe any standing commitments you may have which might conflict with set meeting schedules:*
34. How did you hear about the vacancy on this City Board, Committee or Commission?*

    1. City Hall Information Board
    2. Council, Board, Committee or Commission Meeting
    3. Newspaper
    4. City Website
    5. Word of Mouth
    6. Social Media
36. Applicant’s Statement & Signature

    I hereby submit this as my application for the position I have indicated on the front of this form. I understand that my completion of this form in no way assures appointment. All Board, Committee, and Commission vacancies will be filled by citizens deemed most qualified to serve in a particular capacity. I also understand that in the event that I am appointed to a position, my activities will be governed by the Massachusetts Conflict of Interest Law (M.G.L. c. 268A), the Massachusetts Open Meeting Law (M.G.L. c. 39), the Massachusetts Public Records Law (M.G.L. c. 66), the Massachusetts Campaign Finance Law (M.G.L. c. 55), the Amesbury City Charter and ordinances, and all other applicable federal, state, and local laws or regulations.

38. Electronic Signature*
39. Date*
    Date
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field