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Advisory Committee Application

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Use the application below to apply for all advisory committees.


For a list of current committee vacancies, please visit the Citizen Committees page.

ADVISORY COMMITTEE APPLICATION

Please correct the field(s) marked in red below:

1

Committee/Date Available:

 *
2
Name:
 *
Name:
3
Home Address:
 *
Home Address:
4
Contact Info:
Contact Info:
5
Do you reside within the city limits of Bend?
 *
Do you reside within the city limits of Bend?
6
Indicate reason(s) you would like to serve on this voluntary board, committee, or commission:
7
Special skills, interest, hobbies that you believe would bring special value to your ability to serve on this committee:
8
Current/Most Recent Employment:
Current/Most Recent Employment:
9
Previous Employment:
Previous Employment:
10
Previous Employment:
Previous Employment:
11
Education and Training:
Education and Training:
12
Other volunteer, committee, board, or commission experience:
Other volunteer, committee, board, or commission experience:
13
If you are still serving in this capacity, do you foresee any conflicts between this committee and the position you currently hold?
 *
If you are still serving in this capacity, do you foresee any conflicts between this committee and the position you currently hold?
14
Other volunteer, committee, board, or commission experience:
Other volunteer, committee, board, or commission experience:
15
If you are still serving in this capacity, do you foresee any conflicts between this committee and the position you currently hold?
 *
If you are still serving in this capacity, do you foresee any conflicts between this committee and the position you currently hold?
16
Other volunteer, committee, board, or commission experience:
Other volunteer, committee, board, or commission experience:
17
If you are still serving in this capacity, do you foresee any conflicts between this committee and the position you currently hold?
 *
If you are still serving in this capacity, do you foresee any conflicts between this committee and the position you currently hold?
18
How did you hear about this position?
How did you hear about this position?
19
Do you have any neighbors, friends or relatives presently working for the City of Bend?  If yes, please list.
20
References:
References:
21
I affirm that the information in this application is true to the best of my knowledge.  I understand that misrepresentation ond/or omission of facts are cause for removal from any advisory committee, board or commission I may be appointed to.  I also understand that the City policy requires disclosure of actual or potential conflicts of interest by persons appointed by the Mayor and Council to any committee.  All information/documents related to service on this committee is subject to public records disclosure.
 *
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If you need assistance with this form or would like to obtain this information in an alternate format, you may request assistance from the Accessibility Program.

  1. To receive a copy of your submission, please fill out your email address below and submit.
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