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Town of Bluffton Boards, Commissions and Committees Application

2. General Information

4. Name*

6. Home Address*

7. Subdivision*

9. City*

10. State*

11. Zip Code*

13. Mobile Phone Number

14. Home Phone Number

15. Work Phone Number

17. Email Address*

19. Beaufort County Voter Registration Number*

21. Occupation

23. Occupation*

    If retired, state former occupation

24. Employer*

    If retired, state former employer

26. Residency, Business and Property Ownership

28. Do you live within the Town of Bluffton's municipal limits?*

    1. Yes
    2. No

30. Do you own property within the Town of Bluffton's municipal limits?*

    1. Yes
    2. No

31. Property Address

33. Do you own a business located within the Town of Bluffton's municipal limits?*

    1. Yes
    2. No

34. Business Name

36. Town of Bluffton Business License number(s)

38. Boards, Commission and Committees Preference(s)

40. Please indicate, in preferential order, up to three Boards, Commissions and/or Committees on which you would like to serve

42. 1*

44. 2

46. 3

48. Please provide an explanation of why you would like to serve on your preferred Board, Commission and/or Committee selection(s)*

50. Please describe how your educational background, work experience or other life experiences qualify you to contribute to the mission(s) of the requested boards, commissions and/or committees *

52. Education and Affiliation

54. Education*

56. Employment History*

58. Professional Affiliations

59. Service Club and/or Affiliation Memberships

61. Are you currently a member of any Federal, State and/or Local Board, Commission or Committee*

    1. Yes
    2. No

62. If YES, please list

64. Please add any additional information you feel would be pertinent to your application

66. If available, please include a copy of your resume and/or biography with your submission

67. Please include a photo copy of a government issued ID *

71. The State Ethics Act provides that no public official, public member or public employee may knowingly use his official office, membership or employment to obtain an economic interest for himself, a member of his family, an individual with who he is associated or a business with which he is associated.
    If you have any questions regarding this law, please call Kimberly Chapman, Town Clerk at 843-706-4505.

    If you have any questions regarding this law, please call Kimberly Chapman, Town Clerk at 843-706-4505.

73. 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. Electronic Signature

75. First Name*

76. Last Name*

77. Date*
    Date

79. All information contained no this application is subject to public disclosure and will be reviewed by public officials.
    All applications are kept in the Town's Talent Bank for two years.

    All applications are kept in the Town's Talent Bank for two years.

81. Next Steps:
    Your application will be forwarded to the appropriate member of Town staff who will contact your for a phone interview to discuss your application, eligibility and next steps in the review process.

    Your application will be forwarded to the appropriate member of Town staff who will contact your for a phone interview to discuss your application, eligibility and next steps in the review process.

85. OFFICIAL USE ONLY

87. Date Received

88. Acknowledgment Sent

90. Routed To

91. Phone Interview Date(s)

93. Appointed To

95. Appointment Date

96. Term Begins

97. Term Ends

Leave This Blank:


99. 1. Receive an email copy of this form.
100. Email address

     This field is not part of the form submission.

101. Submit

* indicates a required field