All fields in Red are required.
BOONE COUNTY
APPLICATION FOR BOARDS AND COMMISSIONS

Please select one or more Boards or Commissions
Animal Shelter Advisory Board   Arboretum   Boone County Health Board
Board of Adjustments   Fire District   Historical Preservation
Independent Health District   Noise Abatement   Planning Commission
Port Authority   Sanitation District 1   Tank
Tax Board   Telecommunications   Tri-Ed
Water District   Other  

 

PERSONAL INFORMATION:



Last Name:
 First Name:
 Middle Name:

How long have you lived in Boone County?
Years

Home Address:
 City:
 State:
 Zip Code:
Home Phone Number:
 Mobile Phone:
 Date of Birth:
   
Your Occupation:
 Business Phone:
 Business Fax:
 E-Mail Address:
Current Employer:
 Spouse's Last Name:
 Spouse's First Name:
 Spouse's Employer
Your Business Address:
 City:
 State:
 Zip Code:


EDUCATION AND GENERAL QUALIFICATIONS:
Level Name Of School Number of Years Attended Did you Graduate Major Course(s) of Study
High School


College/Other


Memberships in Community Organizations
Indicate Any Public Office You Have Held


HAVE YOU EVER BEEN CONVICTED OF A FELONY?
If yes, please indicate charge, date and place.


REFERENCES (List two persons not related to you, whom you have known for at least one year)
Last Name: First Name: Phone Number:
Years Acquainted:
Address: City: State: Zip Code:

Last Name: First Name: Phone Number:
Years Acquainted:
Address: City: State: Zip Code:



     

If you have questions or comments regarding this form please contact Melanie Morris at (859) 334-2242