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2. Public Service Opportunities are offered by the City of Plainview without regard to race, color, national origin, religion, sex, marital status or disability.

4. Qualification: Except as otherwise provided by the City’s Code of Ordinances or other applicable law, all City Board, Commission and Committee appointees must continuously reside within and be eligible to become registered voters of the City of Plainview, Texas to qualify for appointment.

    NOTE: The information provided in this application is not considered confidential and could be subject to public disclosure upon proper request pursuant to the Texas Public Information Act.

6. First Name*
7. Last Name*
9. Residential Address:*
11. Mailing Address:*
13. Do you live inside the city limits of Plainview?*
    -- Select One --YesNo
14. City District*
    -- Select One --1234567
16. If Yes, how many years as Plainview resident?*
18. Home Phone*
19. Cell Phone*
21. Email Address:*
23. Are you a registered voter or eligible to become a registered voter?*
    -- Select One --YesNo
25. Occupation *

    (If retired, list former occupation)

27. Employer*
29. Business Address:*
31. Business Phone #:*
33. Information on City of Plainview boards
    City of Plainview Boards, Committees and Commissions
35. I am interested in serving on the following board, commission or committee:*

    (Writing "all" or "any" is not an acceptable answer) 

37. Previous experience on boards, commissions or other civic organizations:
39. Organization
40. City, State
41. Dates
42. Role
44. Please describe your education, professional affiliations, special knowledge, qualifications or expertise that relates to your possible appointment:*
46. Please give a brief statement explaining why you would like to be appointed to the Board, Commission, and/or Committee you've selected above:*
48. In your own words, what is the purpose of the Board, Commission and/or Committee for which you are applying?*
50. What do you hope to personally contribute to the community by serving on the Board, Commission, and/or Committee for which you are applying?*
52. Have you attended one or more meetings of the Plainview City Council?*
    -- Select One --YesNo
54. Have you attended one or more meetings of the Board, Commission, and/or Committee for which you are applying?*
    -- Select One --YesNo
56. Feel free to attach a resume/CV and/or any other applicable information for City Council to consider with your completed application.
58. There is no guarantee of an appointment by submitting this application. All applications will be kept on file for one year unless subsequently withdrawn by the applicant.

    As evidenced by my signature below, I certify that all of the statements contained herein and any information attached here are true and correct as to every material matter.  I understand that there is no guarantee of appointment by submitting this application.  I understand that maintaining the confidentiality of information contained in my application may not be legally possible under the Texas Public Information Act and I hereby release the City of Plainview, its agents, employees and officers from any and all liability related thereto. 

60. Date
    Date

    Date
62. 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.

    1. I agree.
64. Electronic Signature
Leave This Blank:


66. 1. Receive an email copy of this form.
67. Email address

    This field is not part of the form submission.

68. Submit

* indicates a required field