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Committee Appointee Application

Steps

1. Step One This section is complete This section is incomplete
2. Step Two This section is complete This section is incomplete

Step One

First Name*
Last Name*
Home Address*
City*
State*
Zip*
County Board District*
You can look up your address to find your district at https://bit.ly/2CsS8UZ.
Business Name
Business Address
City
State
Zip
Cell Phone*
Other Phone
Email Address*
Preferred Method of Contact*
1. Email
2. Cell Phone
3. Other Phone
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Step Two

Which committee are you applying to serve on?
If you have previously served on a Peoria County committee, please list it below along with the dates served.
Are you reapplying for a committee you currently sit on?*
1. Yes
2. No
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:*
Are you able to regularly attend the scheduled meetings of the appointed body? *
1. Yes
2. No
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.
Resume*
Please upload a resume or biography.
References*
Please upload your references.
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.
1. I agree.
Electronic Signature

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Email address

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Committee Appointee Application

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