Appointment Application (Web Fillable Form)

The Select Board shall not discriminate against an applicant based on religion, age, sex, marital status, race color, ancestry, national origin, sexual orientation or physical or mental disabilities. The Select Board may exclude from consideration any applicant with physical or mental disabilities only when the physical or mental handicap would prevent the applicant from performing the duties of the appointment and reasonable accommodation cannot be made.

The Select Board shall have final authority over the appointment of citizens to Boards, Committees and Commissions that are instruments of Town Government. The Select Board shall not appoint an applicant to a position for which the applicant will likely have a frequent or recurring conflict of interest.

Date *

Month

Day

Year

Which Board, Committee or Commission are you applying for? *

Do you have previous experience on this board or committee? *

	Yes	No
Do you have previous experience on this board or committee? *	Do you have previous experience on this board or committee? - Yes	Do you have previous experience on this board or committee? - No

Name *

Street Address *

Mailing Address *

Phone (Primary) *

Phone (Secondary)

E-Mail *

Below please tell us of any experience and/or training that might be useful in this position. *

If you are currently employed, what is your position? *

Below please tell us the reason you are interested in applying for this position. *

Electronic Signature *

"By signing this application for this position the Applicant understands and agrees that the information contained in this application is required by law to be available for public viewing and agrees to hold the Town of Readfield harmless from any misuse of the application information by anyone viewing it. As a member of this board, committee or commission

Check one! *

	I DO	I DO NOT
I DO/DO NOT approve the use of my contact information (address, email, phone) on the Town's public sites and publications. *	I DO/DO NOT approve the use of my contact information (address, email, phone) on the Town's public sites and publications. - I DO	I DO/DO NOT approve the use of my contact information (address, email, phone) on the Town's public sites and publications. - I DO NOT

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Appointment Application (Web Fillable Form)