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If you have previously served on a Peoria County committee, please list it below along with the dates served.

Briefly explain why you would like to be considered for a Peoria County volunteer commission or committee and what you hope to accomplish if appointed:*

Please complete the following as it relates to the relevancy of the committee/appointment you are applying for:

Educational Background

Professional and Employment Background

Community Volunteer Experience

Have you ever been convicted of a felony? If yes, please provide date(s), location(s), and penalties.*

Convictions are evaluated for each position and are not necessarily disqualifying.

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. I certify that the above information is true and correct. To the best of my knowledge, there is no conflict of interest for me or my spouse.

I agree.

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Committee Appointee Application

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