3. 
5. City of Kinston Citizen Board/Commission Application
7. I, the undersigned am a registered voter in Lenoir County and have an interest in community service and I am providing this information for use by the City Council and considering my qualifications for appointment to the following Board(s) or Commission(s).
9. Please number your preferences, up to four, in the order of priority for the board or commission on which you wish to serve.
11. Selection Preferences

    1. Board of Adjustment/Planning Board
    2. Kinston Housing Authority
    3. Lenoir County Tourism Development Authority
    4. Parks and Recreation Commission
    5. Utility Advisory Commission

    1. Historic District Commission
    2. Kinston-Lenoir County Library Board
    3. Neuse Regional Water & Sewer Authority
    4. Pride of Kinston Board of Directors
13. Full Name*
15. Home Address*
16. City*
17. Zip Code*
19. Employer/Company
20. Position/Title
22. Preferred Contact #*
23. Alternate Contact #
25. Email Address*
27. Do you reside inside the City limits?
28. Extra Territorial Jurisdiction?
29. How long?
31. Why are you interested in serving on this board/commission? (Use additional Sheet of paper if needed)
33. How did you hear about this board/commission vacancy?
35. Please describe your current and past Civic or Community involvement.
37. Do you have any special skills, experience, or background which would assist you with working on this board/commission?
39. Applications will remain on file for one year.
41. No member of the City of Kinston's Boards and Commissions may discuss, advocate or vote on any matter in which he or she has a separate, private or monetary interest, either direct or indirect. The member who has such interest in any official act or action shall publicly disclose on the record of the Board or Commission the nature and extent of such interest, and shall withdraw from any consideration of the matter if excused by the Board or Commission.
43. By signing this application, you hereby acknowledge the potential for a background check, the conflict-of-interest clause stated above, the potentiality that your information submitted may become public, as well as the individual by-laws and/or rules of procedures which dictate your role as a volunteer board/commission member.
45. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
47. Electronic Signature
48. Date*
    Date

    Date
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field