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Board/Commission Application

Upon completion of this application, you should receive the following message: "Thank you.  Your application has been submitted and we will be contacting you soon."
If you do not receive this message, call (541) 682-5882.
(Bold fields are required)
Name
First  
Last  
Middle Initial  
Address
Street  
City  
State  
Zip  
Phone Numbers
Evening   
Daytime  
Residence
Do you reside within the city Limits?  
If so How Long?
(specify years, months)
  
City Council Ward  
Neighborhood Organization  
Work
Occupation (or Retired or Student)     
Employer  
Business Address  
City  
State  
Zip  
Fax Number  
Additional Information
Email  
How did you learn of this vacancy?  
Optional Information
Gender  
Age  
Ethnicity  
Disabled?
Residence
Household income, annual estimate  
Languages you speak
other than English
First Additional  
Second Additional  
Questions
Education & Training
(250 characters)
Please list school course work, degrees, vocational training, licenses, certifications, or similar qualifications that have helped prepare you for serving on this board or commission.
  
Jobs
(250 characters)
  
Community Service/Volunteer
(250 characters)
  
Personal Experience
(250 characters)
  
Personal Interests Briefly describe your personal interests and how they relate to your decision to apply for a position on a board or commission.
 
Contribution What specific contribution do you hope to make to the board or commission?
Why do you want to become a member?
 
Board or Commission Applying
First Choice
 
 
Terms and Conditions:  I hereby certify that I have answered truthfully and have not knowingly withheld any information relative to my application.  I agree and understand that any misstatements or material omissions on the application will result in my being eliminated from future consideration.  I understand that, if accepted, any misrepresentation or material omission which becomes known to the City of Eugene my result in my immediate dismissal.
Type "I Agree" to accept the above Terms and Conditions.   
Upon completion of this application, you should receive the following message: "Thank you.  Your application has been submitted and we will be contacting you soon."
If you do not receive this message, call (541) 682-5882.