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2. Date *
   Date
4. Name:*
6. Address*
8. City*
9. State*
10. Zip Code*
12. Phone Number
13. Cell Number
15. Email Address*
17. Year Moved to Vienna*
19. Experience that would prepare you for service as an advisor to City Council: (Do not list employers' names or attach resume.)*
21. Academic Credentials: (Please list courses taken that would relate directly top public administration/problem solving.*
23. Membership on boards and commissions often entails several evening meetings throughout the year. Normally most boards and commissions meat at least once monthly, with an occasional extra meeting per month.
25. Can you be expected to be available for these meetings?*

    1. Yes
    2. No
27. Is there any particular evening(s) per month on which you could normally not be available?

    1. Sundays
    2. Mondays
    3. Tuesdays
    4. Wednesdays

    1. Thursdays
    2. Fridays
    3. Saturdays
29. Have you served, or do you currently serve, on boards or commissions of other jurisdictions?*

    1. Yes
    2. No
31. Please explain where you served and in what capacity.*
33. In what civic or service organizations are you active?*
35. Would your membership in such organizations or your professional association(s) or business activity pose any potential conflict of interest or inappropriate association as a member of a city board or commission?*

    1. Yes
    2. No
37. What conflicts would you holding this position pose?*
39. In a few words, please describe your interests in local government and indicate how your appointment to a board or commission would contribute to the overall quality of local government in Vienna:*
41. Which board or commission interests you the most?*
    -- Select One --Board of Zoning AppealsBuilding Safety CommissionCivil Service CommissionLibrary BoardPark BoardPlanning CommissionTransit AuthorityTree CommissionUtility BoardVienna Recreation Improvement Association (VRIA)Visitors and Convention Bureau

    All Boards and commissions details are listed at the end of this form.
43. Why does this board or commission interest you?*
45. Note: The City boards and commissions have a small number of members and relatively few vacancies occur each year. Your application, therefore, may not be acted on immediately but may be held in a citizen "talent bank until such time as a vacancy, or other City project, matching your abilities and interests is available. This application is subject to disclosure under the West Virginia Freedom of Information Act. Your interest in serving the City is sincerely acknowledged and appreciated.
47. List of Boards and Commissions:

    Board of Zoning Appeals - Five member committee hear appeals from planning commission decisions.

    
    

    Building Safety Commission - Commission has the right to duty to investigate and inspect and building which it has reason to believe may be unsafe, unsanitary, dangerous or detrimental to the public welfare.

    
    

    Civil Service Commission - Represents City in Police Department matters.

    
    

    Library Board - It is a five member board.

    
    

    Park Board - Seven member board is responsible for management and control of all Parks, together with all recreation facilities and activities therein.

    
    

    Planning Commission - Eight member committee helps plan for growth and development of the City.

    
    

    Transit Authority - Represents the City at the Mid Ohio Transit Authority (Easy Rider Bus System).

    
    

    Utility Board - Five member board oversees water, sewer, and storm water department.

    
    

    Visitors and Convention Bureau - Represents City on travel and visitor matters.

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53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

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