Create an Account - Increase your productivity, customize your experience, and engage in information you care about.
The purpose of
this form is to provide the Mayor and City Council members with some information about
individuals considered for appointment. This application will be kept on file for two years.
The file of completed applications is open for public inspection upon request.
Please list name, address and phone number.
I, the applicant, for a position as a board or commission member with the City of
Liberty Lake, Washington, in consideration of the review of my application, do hereby give
the City or an independent investigating agency authorization to conduct a thorough
investigation of my professional and personal background, including credit, criminal, driving,
and all data given on this application, on related papers, and in interviews. I authorize all
individuals, schools, and firms named therein to provide any information requested about me.I understand and agree to waive any claim or cause of action relating to use of any and all
information gained through this investigation or release of information, and promise to
defend and hold harmless the City of Liberty Lake, Washington, its officers and employees
from any claim or loss arising from such investigation and/or release of information.It is my intention that any copy of this authorization be as effective as the original.
This field is not part of the form submission.
* indicates a required field