Haltom City Application to Serve on a Board/Commission

CITY SECRETARY
5024 Broadway Ave., Haltom City, TX 76117

Request to Serve on a Board or Commission All information must be furnished in order to be considered. Put "NA" where "not applicable" applies:
Name:	Please check all the Boards & Commissions of interest:
Phone #:	Animal Advisory Beautification Civil Service Crime Control & Prevention Economic Development Fire Services	Housing Authority Library Parks & Recreation Planning & Zoning Sexually Oriented Board of Appeals Zoning Board of Adjustments
Email:
Age(optional):
Employer:	Occupation:	Education:

Home Address:
Street	City	State	Zip Code

Work Address:
Street	City	State	Zip Code

List any special knowledge or experience applicable:		Other information(civic activities, etc.):
Length of continuous residence as of date application is submitted: years months			Only persons who have resided in the city for at least 12 months shall be considered for appointment to city boards and commissions unless otherwise provided in this Code or the ordinance creating such board or commission. Ord. No. O-2001-040-01 § 1, 7-9-01