3. 
5. City of Kinston Historical Grainger Stadium Commission Application

7. I, the undersigned am a registered voter in Lenoir County and have an interest in community service.  I am providing this information for use by the City Council in considering my qualifications for appointment to the above Commission.

9. Full Name*
11. Home Address*
12. City*
13. Zip Code*
15. Employer/Company
16. Position/Title
18. Preferred Contact #*
19. Alternate Contact #
21. Email Address*
23. Do you reside inside the City limits?
24. Extra Territorial Jurisdiction?
25. How long?
27. Why are you interested in serving on this commission? (Use additional Sheet of paper if needed)
29. How did you hear about this commission vacancy?
31. Please describe your current and past Civic or Community involvement.
33. Do you have any special skills, experience, or background which would assist you with working on this commission?
35. Applications will remain on file for one year.

37. 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 Commission the nature and extent of such interest, and shall withdraw from any consideration of the matter if excused by the Commission.

39. 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 commission member.

    After submission of this application, ALL applicants will be emailed an "Applicant's Disclosure for Background Screening" and an "Applicant's Authorization for Background Screening" form for completion and submission to the City Clerk at debra.thompson@ci.kinston.nc.us. 

41. 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.
43. Electronic Signature
44. Date*
    Date

    Date
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field