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Administration

Town Board Application

 

Thank you for your interest in serving on one of the Town of Smithfield’s various advisory boards. Please complete the application below. 

 

If you have any questions regarding our Town Boards or your application, please contact Shannan Parrish.

Name (Last, First, Middle Initial):
Home Address:
Business Name & Address:
Home Telephone:
Mobile Telephone:
Email:
Confirm Email:
Board which you are submitting an application: Check all that apply






Interests and Skills:
Recent Job Experiences:
Civic or Service Organization Experience: If none, please type "N/A" in the box below.
Previous Town Board Experience: Please list any previous Town Board experience along with years of service. If none, please type "N/A" in the box below.
Current Board/Committee Service: Please list any Boards/Commissions/Committees on which you currently serve. If none, please type "N/A" in the box below.
Why are you interested in serving on this Board/Commission/Committee?

Affirmation of Eligibility

Has any formal charge of professional misconduct, criminal misdemeanor or felony ever been filed against you in any jurisdiction?
If "YES" to above question, please explain in the box below:
Is there any conflict of interest or other matter that would create problems or prevent you from fairly and impartially discharging your duties as an appointee of the Smithfield Town Council?
If "YES" to above question, please explain in the box below:
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 and if necessary. 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 Council Board/Commission/Committee is important and, accordingly, I further understand that if my attendance is less than 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 Town Clerk and requests for updates will be sought prior to any consideration for reappointment (or future appointment) to any Board/Commission/Committee. Please type in your full name if you agree to the above statements.