2. City of Dalhart

   
   

   Application for

   
   

   Appointment to City Boards, Commission and Committees

4. 
   

   Name of Board, Commission, or commission which you are applying for:

6. Please select a Board or Committee*

   1. Planning and Zonning
   2. Plumbing Board
   3. Adjustments and Appeals
   4. Airport Advisory Board
   5. Rita Blanca Lake Board

   1. Electric Board
   2. Building Codes
   3. Hotel Occupancy Tax Board (HOT Board)
   4. Dalhart Economic Development Board (Dalhart EDC)
8. First Name
9. Last Name
11. Address
13. City
14. State
15. Zip Code
17. Preferred Mailing Address

    If Different from above

19. City
20. State
21. Zip Code
23. Phone Number
24. Email Address
26. Residence

    How long have you lived in Dalhart?

27. Length of Residence
29. Question 1

    Why do you want to serve on a board, commission or committee?

31. Answer 1
33. Question 2

    Describe your interest and qualifications for the position you desire:

35. Answer 2
37. Question 3

    Do you currently serve on a Dalhart board, commission or committee?

38. Answer 3
    -- Select One --YESNO
40. Question 4

    Have you ever served on a Dalhart Board, Commission or committee?

41. Answer 4
    -- Select One --YESNO
43. If yes to either Question 3 or 4

    Which board, commission or committee did you serve and for how long?

45. Comment
47. Question 5

    Is there any experience you would like to share?  

49. Answer 5
51. Documents

    If you like to submit a resume or any information please do so.

52. Document upload
54. CHECK*

    1. I Agree

55. I read and understand the instructions and appointment process.  I understand the appointments are solely at the discretion of the city council and that this application is not the only basis for candidate selection.

57. 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.
59. Electronic Signature
60. Date*
    Date
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field