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2. Thank you for your interest in serving on an advisory board or commission. 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.
6. Date
   Date

   Date
7. City of Liberty Lake advisory board or commission for which you are applying:
   -- Select One --City Planning CommissionCivil Service CommissionSalary CommissionLibrary Board of TrusteesParks and Arts CommissionOTHER
8. Would your appointment create a conflict of interest or appearance thereof?
   -- Select One --YesNo
12. First Name
13. Last Name
15. Address1
17. Address2
19. City
20. State
21. Zip
23. Home Phone
24. Fax
26. Work Phone
27. Email
31. Employer
33. Business Address
35. Address2
37. City
38. State
39. Zip
43. Are you a registered voter in the City of Liberty Lake?
    -- Select One --YesNo
44. How long have you lived in the City of Liberty Lake (continuously)?
    -- Select One --Less than 1 year1-2 years3-4 years5-6 yearsOver 6 years
48. Educational Background
50. Professional Qualifications / Work Experience
52. Community Activities / Involvement Experience
54. Other Qualifications / Reasons for Desire to Serve
58. Reference #1 Name
59. Reference #1 Phone
61. Address1
63. Address2
65. City
66. State
67. Zip
71. Reference #2 Name
72. Reference #2 Phone
74. Address1
76. Address2
78. City
79. State
80. Zip
84. Reference #3 Name
85. Reference #3 Phone
87. Address1
89. Address2
91. City
92. State
93. Zip
Leave This Blank:


95. 1. Receive an email copy of this form.
96. Email address

    This field is not part of the form submission.

97. Submit Submit and Print

* indicates a required field