Town of Pleasant Garden

P.O. Box 307

4920 Alliance Church Road

Pleasant Garden, North Carolina 27313

____________________________________________________________________________________________________________

Fax: (336) 674-0923                                                          Phone: (336) 674-3002                  E-mail: TownClerk@pleasantgarden.net____

 

BOARD APPLICATION

 

For the purposes of this application, "board" refers to Town boards, commissions, committees and task forces

 

Name (First, Middle, Last )_________________________________________________________________ 

Home address____________________________________________________________________________

Birthdate (Month-Day-Year) _________________________

How long have you lived at your current address?  ______________   If less than 10 years, please list all previous addresses for the past 10 years.   _____________________________________________________

_________________________________________________________________________________________

List all counties that you have lived in during the past ten years ___________________________________

 

Mailing address (if different)_________________________________________________________________

Phone (home &/or cell)___________________________  (work)____________________________________

Fax_____________________________________________        e-mail____________________________________

Do you live within the corporate limits of Pleasant Garden?              (  ) Yes           (  ) No

How long have you been a resident of Pleasant Garden?_____________________________________________

Current membership in organizations and offices held: _____________________________________________

__________________________________________________________________________________________

Past organizational membership and offices held: __________________________________________________

Previous service on any Town board: (  ) Yes (  ) No   Which one(s)?__________________________________

Do you anticipate a conflict of interest by serving as a member of a town board?    ________________________

If so, explain_______________________________________________________________________________

In which board are you interested and why do you want to serve on that board? (Use separate paper if necessary) _________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

State reasons why you feel qualified for this appointment (for example, experience, education, job skills) __________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________


 

                                                 

 

All Applicants

 

To be eligible for appointment to Town boards, candidates must meet the following requirements:

A.                Candidate must be a resident of the Town of Pleasant Garden

B.                 Candidate must be 18 years of age or older

C.                 Candidate must never have been convicted of a felony

D.                 Candidate must never have been convicted of crimes against children

 

(Ord. 10, passed 6/8/99, amended 8/12/08)

 

 

Board Member Declaration:

 

I certify, under penalty of perjury, that I meet the requirements specified above and am eligible to serve on a Pleasant Garden town board.

 

_______________________________________________              _______________________________

Signature                                                                                            Date

 

 

******************************************************************************************

 

Zoning Board applicants

 

The Pleasant Garden Town Council may appoint no more than one full-time real estate professional and/or builder and/or developer of land for sale to others to the Zoning Board. "Full-time" is defined as anyone who, in the past three years, earned 51% or more of their income from work as a "real estate professional and/or builder and/or developer of land for sale to others".

(Ord. 11, passed 6/8/99)

 

Board Member Declaration:

 

I certify, under penalty of perjury, that I  (please circle)         am           am not          a full-time real estate professional and/or builder and/or developer of land for sale to others.

 

___________________________________________                      _______________________________

Signature                                                                                            Date

Note: This information will be used by town officials in making appointments.

If you are appointed, this information may be used as a basis for a news release to identify you to the community.

All advisory board members serve at the pleasure of the Council.