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2. 

3. BOARD OR COMMISSION APPLICATION

5. First Name*
6. Last Name*
7. Date of Application*
   Date of Application
9. Home Address*
11. Home Phone
12. Office Phone
13. Cell Phone
15. Email*
16. Are you a resident of Palestine?*

    1. Yes
    2. No
17. How Many Years?
19. What is your Occupation?
20. What is Your Place of Employment?
22. I would like to serve on the following Board(s) and Commission(s):*

    1. Airport Advisory Board
    2. Economic Development Corporation
    3. Library Board
    4. Parks Advisory Board
    5. Zoning Board of Adjustment and Appeals

    1. Real Estate Committee
    2. Financial Oversight Advisory Committee
    3. Building and Standards Commission
    4. Historic Landmarks Commission

    1. Tourism Advisory Board
    2. Main Street Advisory Board
    3. Planning and Zoning Commission
    4. Civil Service Commission
24. Do you currently serve on any Boards or Commissions?*

    1. Yes
    2. No
25. If yes, list Board(s) or Commission(s):
27. Will you submit to a background check and complete protective training if your Board or Commission interacts with children?

    1. Yes
    2. No
28. Do you have any outstanding debts owed to the City of Palestine?

    1. Yes
    2. No

29. *Only citizens without outstanding taxes, permits, fees, or fines may serve on a Board or Commission*

31. Experiences and qualifications that you feel would make a contribution to a City of Palestine Board or Commission:

33. The City Council will use this application for their selection of individuals for appointments to specific Boards and Commissions. All appointments are made by the Mayor and confirmed by Council. All information provided in this application is public information pursuant to the Texas Public Information Act. All individuals appointed to serve will be required to complete training relative to the Texas Open Meetings Act and to the Public Information Act .

35. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
37. Electronic Signature

39. 504 N. QUEEN STREET – PALESTINE, TEXAS 75801 – (903) 731-8414 – Email: [email protected]

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41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

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