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2. APPLICATION

   NOTE: An applicant must be a resident of Grand Traverse County to qualify for consideration of appointment. Please complete and sign this application and select submit when finished. For more information, call 231-922-4511 or send an email to jchase@gtcountymi.gov.

4. Name
5. Email Address
7. Address
9. City
10. State
11. Zip Code
13. Township
14. Home Phone Number
16. Work Phone Number
17. Cell Phone Number
19. E-mail Address
    (E-mail is the preferred method of contact, so please provide an address, if available.)
20. Is this an application for reappointment to the Natural Education Reserve Advisory Committee?

    1. Yes
    2. No
22. Why are you interested in serving on the Natural Education Reserve Advisory Committee?
24. EMPLOYMENT EXPERIENCE
    If answered in full on your attached resume, then please indicate so.
26. 1. Position, Employer’s Name and Address, and Years Worked:
28. 2. Position, Employer’s Name and Address, and Years Worked:
30. 3. Position, Employer’s Name and Address, and Years Worked:
32. Skills

    What special skills would you bring to this committee appointment?

34. Education
    Include degree, institution, and dates. If answered in full on an attached resume, then please indicate so.
36. PREVIOUS GOVERNMENTAL APPOINTMENTS
38. Attach any supporting documents here.
40. CONSENT AND CERTIFICATION
    I hereby certify that the information contained in this application is true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any misrepresentation, falsification, or omission of information on this application or on any document used to secure appointment, shall be grounds for rejection of this application or immediate discharge if I am appointed, regardless of the time lapsed before discovery. I further understand that all applicants selected to serve are subject to a background check, including criminal history, driver’s record, and Michigan Sex Offender Registry.
42. Electronic Signature Agreement*

    I hereby certify that the information contained in this application is true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any misrepresentation, falsification, or omission of information on this application or on any document used to secure appointment, shall be grounds for rejection of this application or immediate discharge if I am appointed, regardless of the time lapsed before discovery. I further understand that all applicants selected to serve are subject to a background check, including criminal history, driver’s record, and Michigan Sex Offender Registry.

    1. I AGREE.
44. Electronic Signature
45. Date
    Date
Leave This Blank:


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

    This field is not part of the form submission.

49. Submit

* indicates a required field