Application for Boards and Committees — Pasquotank County North Carolina

Name

First Name

Last Name

Address

MUST BE IN PASQUOTANK COUNTY (Some boards have additional residential requiments)

Home/Cell Phone

(###)

###

####

Work Phone (if applicable)

(###)

###

####

Present Occupation/Employer (or past if retired)

Education Level

Completed High School

Some College

Completed College

Advanced Degree

College/University & Degree (if applicable)

Civic & Fraternal Organizations in which you are a member (note any offices held):

List Boards & Committess to which you were appointed and NOW serve on

List Boards & Committees to which you were appointed to and served on in the past:

Which Boards and/or Committees are you interested in serving on

List Reasons for interest in serving on the above boards/committees

By Checking Below, you are acknowledging your application (ie signature) and understand that the information above is considered a Public Record under North Carolina Law.

Yes