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Name |
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First |
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Last |
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Middle Initial |
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Home Address* |
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Street |
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City |
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State |
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Zip |
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*A P.O. box cannot be used as a home address.
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Mailing Address |
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Street |
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City |
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State |
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Zip |
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Phone Numbers |
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Evening |
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Daytime |
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Residence |
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Do you reside within the city Limits? |
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If so How Long?
(specify years, months) |
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City Council Ward |
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Neighborhood Organization |
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Work |
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Occupation (or Retired or Student) |
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| Employer |
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| Business Address |
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| Are you currently and employee of the City of Eugene? |
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Additional Information |
| Email |
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How did you learn of this vacancy? |
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Optional Information |
| Gender |
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| Age |
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| Race |
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| Disabled? |
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| Residence |
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| Household income, annual estimate
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Languages you speak
other than English |
| First Additional |
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| Second Additional |
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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. |
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Jobs
(250 characters) |
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Community Service/Volunteer
(250 characters) |
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Personal Experience
(250 characters) |
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| Personal Interests |
Briefly describe your personal interests and how they relate to your decision to
apply for a position on a board or commission. |
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Contribution |
What specific contribution do you hope to make to the board or commission?
Why do you want to become a member? |
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Board or Commission Applying |
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First Choice |
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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. |
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Type "I Agree" to accept the above Terms and Conditions.
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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. |
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