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2. Eligibility Profile & Demographics

   * Denotes required field.

4. Prefix*
5. Last Name*
6. First Name*
7. Middle Initial
9. Suffix/Title
10. Preferred Name
11. Date of Birth (MM/DD/YY)*
13. Primary Phone Number*
14. Secondary Phone Number
15. Email Address*
17. Permanent Residential Address *
19. City*
20. State
21. Zip*
23. Mailing Address (if different than permanet)

    Street, City, State, Zip

24. Is your permanet residence within the corporate limits of the City of Windcrest? *

    1. Yes
    2. No
26. Number of years residing in Windcrest?*
27. Are you a registered voter?*

    1. Yes
    2. No
28. What is your employment status?*

    1. Full Time
    2. Part Time
    3. Contracted
    4. Retired
    5. Not Working
30. Employer Information
31. Job Title
33. Occupation
34. Length of Employment with Current Employer
38. Types of Boards, Commissions or Committees
40. Check up to three (3) Boards, Commissions, and/or Committee's you are interested in serving.*

    1. Board of Adjustment
    2. Ethics Commission
    3. Parks and Recreation Commission

    1. Planning and Zoning Commission
    2. Windcrest Crime Control Prevention District
    3. Windcrest Economic Development Corportation
42. Recognizing that a Board, Commission, and/or Committee are often demanding on one's time and schedule, are you committed to attending regularly scheduled meetings of the Board, Commission and/or Committee?*

    1. Yes
    2. No
43. How many hours can you commit to devote to serve each month?*

    Number of hours

47. Supplemental Questions
49. Do you or any of your immediate family members or any businesses that you or they own currently have any direct or indirect financial interest in any contract(s) with the City, including subcontracts?*

    1. Yes
    2. No
51. Will you or any of your immediate family members or any businesses that you or they own seek a contract(s) with the City in the foreseeable future? *

    1. Yes
    2. No
53. Do you or any of your immediate family members or any businesses that you or they own have any financial interest, direct or indirect, in any sale to the City of any land, materials, supplies, or service?*

    1. Yes
    2. No
55. Does your employer or an employer of your immediate family members have a contract with the City?*

    1. Yes
    2. No
57. Do you currently serve in any elected or appointed public government office?*

    1. Yes
    2. No
59. Are you a member and/or officer and/or employee of any local, state, or national boards, commissions, corporations, non-profit entities, agencies, or other entities?*

    1. Yes
    2. No
61. If yes, please provide a list. If no, leave blank.
63. Do you intend to seek election or appointment to any local, state, or national public office or board or commission in the foreseeable future?*

    1. Yes
    2. No
65. Do you have any relatives who are employed with the City of Windcrest, Windcrest Fire Department or Windcrest Police Department?*

    1. Yes
    2. No
69. Education, Public Service, and Professional Background
71. Please select your highest level of education.*

    1. High School Graduate/GED
    2. Some College
    3. Associate Degree
    4. Bachelor Degree

    1. Master Degree
    2. Doctoral Degree
    3. None of the Above
73. Please provide concentration of study.
75. Describe your Professional History & Certification designations (current and historical).*
77. Describe your Volunteer Experience & Community Service.*
79. Please provide a brief narrative outlining your reasons for seeking appointment to this board or commission.*
83. Acknowledgements, Authorizations and Signature
85. Public Information Act*

    I understand that if any member of the public makes a request for information included in this Application for Appointment, most of the information must be disclosed under the Public Information Act. I understand that the City of Windcrest will attempt to maintain the confidentiality of highly private matters by seeking an Attorney General's opinion in accordance with the Public Information Act. 

    I understand that it may not be legally possible to maintain the confidentiality of such information, and I hereby release the City of Windcrest, and its agents, employees and officers, from any and all liability whatsoever if the information must be released pursuant to the Public Information Act or any other law requiring its release. * Check to acknowledge

    1. Check to acknowledge
87. Do you consent to the City conducting a background check on you?*

    1. Yes
    2. No
89. Background and Criminal History*

    I further request, as a part of my application, that all law enforcement officials and criminal justice agencies release any criminal history records concerning me to the Windcrest Police Department and/or the Office of the City Secretary of the City of Windcrest in order that qualifications may be checked. * Check to acknowledge

    1. Check to acknowledge
91. OATH:*

    I have read and understand the guidelines set out in this application. The foregoing statements are true, accurate, and complete. I agree that any misrepresentation or omission of facts may result in my disqualification for appointment. * Check to acknowledge

    1. Check to acknowledge
93. Signature (Enter/Type name as signature)*
94. Date of Submission*
    Date of Submission
96. You may uplaod any additional information, such as a current resume/CV, certifications, by clicking the CHOOSE FILE button below.
Leave This Blank:


98. 1. Receive an email copy of this form.
99. Email address

    This field is not part of the form submission.

100. Submit Submit and Print

* indicates a required field