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Application for Membership to a Board, Commission or Committee

2. Board, Commission or Committee of interest:*
   -- Select One --Board of Assessment ReviewLibrary Advisory CommitteeParks & Cemeteries Board of TrusteesPlanning BoardPublic Safety CommissionRecreation & Conservation CommissionRegistration Appeals BoardSewer CommissionVeteran Services Advisory CommitteeVillage Review Overlay Zone CommitteeWestbrook Environmental Improvement Corporation (WEIC)Westbrook Housing AuthorityZoning Board of AppealsOther/Unknown (select if have no preferred board, commission or committee)
4. Type of Application

   1. New

   1. Renewal
6. Name*
7. Email Address*
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
19. Please describe why you are interested in serving on this board or committee and if you have any special qualifications:*
21. Please provide brief background information about yourself:*
23. Have you attended a meeting?*

    New applicants are strongly encouraged to attend at least one meeting of the board, commission or committee to which they are applying prior to submitting an application for appointment. If not, please contact the Mayor's Office at 591-8110 for assistance in determining a date/time to attend a meeting.
    
    

    1. Yes

    1. No
25. Are you available for evening meetings?*

    1. Yes

    1. No
27. Are you willing to attend educational or training sessions relevant to the board or committee? *

    1. Yes

    1. No
31. References
    Please note if you have any relevant references that we may contact.
33. Name
35. Address
37. City
38. State
39. Zip
41. Phone
43. Relationship
44. Years Acquainted
46. Upload Resume
    Please upload a copy of your resume, if available.
50. Authorization of Background Investigation*

    I hereby authorize the City of Westbrook to conduct an Investigation through the Motor Vehicle Division of the Maine Secretary of State for vehicle related record checks and through the Maine State Bureau of Identification or other source for criminal record checks. I hereby release the City of Westbrook from any and all liability for any claims or damages arising out of its investigation as outlined above or from the City's use of the information provided.
    
    I understand that if l do not agree to execute this, I will not be considered as a board, commission or committee member for the City of Westbrook, and that any misrepresentation of information contained herein will preclude me from consideration as a board, commission or committee member with the City of Westbrook.
    
    

    1. I authorize a background investigation.
54. Next Steps
    The Mayor's Office will review all applications submitted for membership to a board, commission or committee. If an opening exists, you may be contacted for a meeting with the Mayor, Department Head and/or Chair of said board, commission or committee to discuss your application.
    
    Thank you for your interest in serving our community!
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field