Town of Pleasant Garden
4920 Alliance Church Road
Pleasant Garden, North Carolina 27313
For the purposes of this application, "board" refers to Town boards, commissions, committees and task forces
Name (First, Middle, Last )_________________________________________________________________
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)____________________________________
How long have you been a resident of Pleasant Garden?_____________________________________________
Current membership in organizations and offices held: _____________________________________________
Past organizational membership and offices held: __________________________________________________
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) __________________________________________________________________________________________
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.
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.
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.