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Please Review
The City of Jacksonville appreciates your interest in serving on a City Advisory Board or Committee. Please review the Qualifications for Service and Advisory Board Descriptions and then complete all sections of this application.
Level of Interest*
List your board / committee interest in priority order. You may express interest in up to two committees but may serve on only one.
1. Board of Adjustment
2. Neighborhood Improvement Services Advisory Committee
3. Environmental and Appearance Advisory Committee
4. Planning Advisory Board
1. Recreation and Parks Advisory Committee
2. Water and Sewer Advisory Committee
3. Onslow County Civic Affairs Committee
4. Leadership Development Program
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Title
First Name*
Last Name*
Home Address*
City*
North Carolina
Zip Code*
Work Name & Address
City
State
Zip Code
Primary Phone*
Work Phone
Cell Phone
Email Address
Are you registered to vote in Onslow County?*
1. No
1. Yes
Do you reside within the Jacksonville City limits?*
1. No
1. Yes
For how long?
Interested in serving as a Leadership Development member?
If yes, please enter 'yes' and your initials in the box provided indicating your interest and that you have read the description of the Leadership Development Program
Are you interested in being contacted for service on various Ad Hoc and/or special committees that may be established in the future by the City Council?
If yes, please enter 'yes' and you initial in the box provided indicating your interest.
I have read the qualifications for appointment and committee information:*
1. Yes
1. No
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Community Involvement
Please describe your current and past Civic or Community involvement.
Special Talents, Experience, Education & Training
Please describe special talents, experience, education, or training that you feel qualifies you for service on the selected board or committee.
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Have any formal charge of professional misconduct ever been upheld against you in any jurisdiction?*
1. No
1. Yes
If yes, please explain complete disposition:
Have you ever been convicted of a criminal misdemeanor or felony in any jurisdiction?*
1. No
1. Yes
If yes, please explain complete disposition:
Is there any possible conflict or other matter that would create problems or prevent you from fairly and impartially discharging your duties as an advisory committee appointee of the City Council?*
1. No
1. Yes
If yes, please explain:
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Terms & Conditions
By my signature, I certify that the facts contained in this application are true and correct to the best of my knowledge. I understand and agree that any misstatement could result in removal from any board or committee to which I am appointed. I understand that appointment interviews are a part of the appointment process and I agree to participate in such interview.

I acknowledge that as an advisor to the mayor and Council of the City of Jacksonville, my past and present actions impact the city, its reputation, and image. I certify that nothing in my past or current life is of a nature that would bring embarrassment or reflect negatively upon the city. Furthermore, I understand that any action, whether criminal or personal, which would bring or potentially bring a negative image or reflection to the City of Jacksonville will result in my removal from my position as an advisor to the City Council.

I understand that this application is a public record.
I have read and I agree to the terms and conditions listed above:*
1. No
2. Yes
Your Signature
Enter your name in the box provided. This is your electronic signature.

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