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2. Board/Commission/Committee Applying For
4. Applicant Name
5. Street Address
6. City
8. State
9. Zip
10. Phone
12. Email Address
13. Election District in which your home residence is located:
15. Employer
16. Employer Address
17. Employer Phone
19. Occupation/Title
20. Date of Beginning Employment
    Date of Beginning Employment
22. Number of Years as a Resident of Franklin County
23. Previous Place of Residence
24. Spouse's Name
26. Education (Degrees & Graduation Dates)
27. Memberships in Fraternal, Business, Church and/or Social Groups
29. Public, Civic and Charitable Office and/or other activities or interests:
30. Reason(s) for wishing to serve on this Board/Commission/Committee:
34. File Upload

    If you wish to add more information, you may attach a document or file here. If not, please sign and SUBMIT.

36. Attachment
40. Electronic Signature Agreement

    By typing your name, you are certifying that you have read and agree with the following statement in its entirety; I agree that my typed name on this document is the legally binding equivalent to my handwritten signature. I will not, at any time in the future, repudiate the meaning of this signature or claim that this signature is not legally binding.

    1. I agree.
42. Electronic Signature
44. NOTE: The information provided on this application may be released to the public upon request. Appointments are subject to clean background checks.
Leave This Blank:


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

    This field is not part of the form submission.

48. Submit

* indicates a required field