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City of Lincolnton
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Boards and Commissions Application

  1. Application for Boards/Commissions/Committees

  2. Please complete each section

  3. It is the City Council’s goal to maintain a balance of membership on its Boards/Commissions/Committees based on race, gender and Council Ward residency.

  4. Generally, the Council desires to broaden participation on Boards /Commissions /Committees for as much citizen involvement as possible; therefore, a goal is to limit appointees to no more than 1 Board/Commission/Committee. Therefore, please list any other Board/Commission/Committee on which you currently serve in the box below:

  5. Affirmation of Eligibility:

    Has any formal charge of professional misconduct, criminal misdemeanor or felony ever been filed against you in any jurisdiction?

  6. Is there any conflict of interest or other matter that would create problems or prevent you from fairly and impartially discharging your duties as a appointee of the City Council?

  7. I understand this application is public record and I certify that the facts contained in this application are true and correct to the best of my knowledge. I authorize and consent to background checks and to the investigation and verification of all statements contained herein as deemed appropriate. I further authorize all information concerning my qualifications to be investigated and release all parties from all liability for any damages that may result from this investigation. I understand and agree that any misstatement may be cause for my removal from any Board/Commission/ Committee. I understand regular attendance to any Board/Commission/Committee is important and, accordingly, I further understand that if my attendance is less then the standards established for any such body that this is cause for removal. Lacking any written standards for attendance by any Board/Commission/Committee it is expected that I will attend at least 75% of all meetings during any one calendar year to maintain my seat on any Board/Commission/Committee to which I may be appointed. This form will remain on file in the Office of the City Clerk and requests for updates will be sought prior to any consideration for reappointment (or future appointment) to any Board/Commission/Committee.

  8. Form is invalid if not signed and dated

  9. Leave This Blank:

  10. This field is not part of the form submission.