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2. Review responsibilities for boards and commissions for which you are applying.
   Responsibilities
4. Applicant
6. First Name*
7. Last Name*
9. Street Address*
11. Mailing Address (if different than above)
13. City*
14. State*
15. Zip*
17. Primary Phone:*
18. Alternate Phone:
20. Email*
22. Do you live within the City limits?*

    1. Yes
    2. No
23. View Ward Map
    View Ward Map
24. If yes, select Ward
    -- Select One --Ward 1Ward 2Ward 3Ward 4
26. Board(s)or Commission(s) you are applying for:*

    1. Americans with Disabilities Act Compliance Committee
    2. Board of Fire and Police Commissioners
    3. Board of Trustees of the Police Pension Fund
    4. Electrical Commission
    5. Emergency Management Agency
    6. Heritage and Preservation Commission

    1. Library Board
    2. Plan Commission
    3. Parks and Recreation Advisory Board
    4. Warderman Cemetery Board of Managers
    5. Other (Specify in next field)
28. Other
30. If applicable, category applying for (funeral home representative, architect, etc.)
32. Current employer*
    If retired or unemployed, indicate previous place of employment. If student, indicate the high school or college you currently attend. Otherwise, indicate "not applicable."
34. Position/Title*
    Indicate position or title if employed, otherwise indicate status as: retired, unemployed, student or homemaker.
36. Office phone
38. Product or service rendered by employer*
    Indicate "not applicable" if not currently employed.
40. Current community service to include other Boards and Commissions on which you currently serve:
42. Past community service
44. Why do you wish to serve on this board or commission?*
46. What experience or qualifications do you have relating to the function of the board or commission?*
48. Do you have monetary interest, direct or indirect, in any pending or incomplete transaction or contract to which the City is or is to be a party?*

    1. Yes

    1. No
50. Does any family member have any monetary interest, direct or indirect, in any pending or incomplete transaction or contract to which the City is or is to be a party?*

    1. Yes

    1. No
52. If you answered yes to either of the above, please explain:
54. Other information or comments:
56. Have you read the duties and responsibilities of the board or commission for which you are applying?*

    1. Yes

    1. No
58. References
60. Reference 1:
62. Reference 1 Name:
64. Reference 1 Address
66. Reference 1 Phone
68. Reference 2:
70. Reference 2 Name
72. Reference 2 Address
74. Reference 2 Phone
76. Resume
78. Upload resume

    Attachment: 20 MB limit: (.pdf, rtf., .odt, .doc, .docx only)

80. Survey
82. How did you hear about this board or commission vacancy

    1. City of Columbia Website
    2. Social Media
    3. City utility bill
    4. Electronic Sign
84. Other
86. Please note: *

    1. By submitting this form, you affirm that the information contained in this application is true and accurate to the best of your knowledge and that you are the person named in the applicant section.
Leave This Blank:


88. 1. Receive an email copy of this form.
89. Email address

    This field is not part of the form submission.

90. Submit Submit and Print

* indicates a required field