Section 1 of 1 in this document

Application for Prospective Board Members

Please select the City Board, Commission, or Committee to which you are applying.

Prospective Board Member

Personal Phone Number

Business Phone Number

Years resided in city of Pocatello?

Occupation/Title

Educational Background

Are you currently serving on another animal welfare volunteer board, and if so, what organization?

Attendance Policy

The City of Pocatello’s attendance policy for advisory board members allows for only three unexcused absences within a 12-month period. Unexcused absences and/or excessive excused absences are grounds for removal from the advisory board.

Acknowledgement

I acknowledge the City of Pocatello has an attendance policy for advisory board members and acknowledge that I can meet this requirement.

Signature

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Service Information

Please select the talents, skills or expertise that you feel would be useful to the board.

Financial Skills

Legal Skills

Community Relations Skills

Planning Skills

Evaluation Skills

Legislative/Political Skills

Approximately how many hours per month would you be able to spend on board activities?

Are you willing to do fundraising, if applicable?

Yes

Have you served on any other City Boards?

Yes

Which board(s) have you served on?

Please list community contacts or affiliations which might relate to your role as a board member.

Please state briefly why you would like to serve on the board and how your skills might make a positive contribution to the board.

You may attach a letter with additional information if you desire.

Applications are kept on file and considered active for one year from the date received.

Applications may also be hand-delivered to the Mayor’s Office at 911 North 7th Avenue, mailed to: Mayor’s Office, City of Pocatello, P.O. Box 4169, 83205-4169 or e-mailed to anichols@pocatello.gov.

Application for Prospective Board Members

Prospective Board Member

Name

Home Address

Attendance Policy

Acknowledgement

Signature

Service Information

Please select the talents, skills or expertise that you feel would be useful to the board.

Are you willing to do fundraising, if applicable?

Have you served on any other City Boards?

You may attach a letter with additional information if you desire.