REQUEST to SERVE APPLICATION

for the

BLOUNT COUNTY ETHICS COMMITTEE

Instructions

: The Blount County Commission believes that all citizens should have the opportunity to participate intheir government. One way to participate is by serving as a citizen member of the Blount County Ethics Committee.The following information is requested by the Blount County Commission on each nominee for appointment, but youmay attach additional information as needed.

Please include your resume.

Return your completed application to the Blount County Commission Office, 359 Court Street, Maryville, TN 37804-5906. If you have questions you may call Betsy Cunningham in Human Resources at 865-273-5781 or send an email to bcunningham@blounttn.org.

ALL INFORMATION ON THIS FORM IS PUBLIC RECORD

Date

submitted

________________

Please type or print clearly.

Name: _______________________________________________________________________________Mailing Address:______________________________ City____________ State ____Zip ________Telephone: Home________________ Work _________________ Cell______________________E-Mail Address:_________________________________________ Education: ____________________Employer: ____________________________ Occupation: ____________________Are you a registered voter in Blount County? ______ Yes ______ No ______ Comm. District _____Can you attend meetings: During business hours? ______ Yes ______ No ______ Sometimes ______Evenings available? Monday ____ Tuesday____ Wednesday____ Thursday____

1. Why would you like to be considered for this appointment?

____________________________________________________________________________________________________________________________________________________________________________________________________________

What work, volunteer or life experiences have you had that would benefit this committee and the citizens of this community?

3. Please list present and past county boards, commissions or committees on which you have served, or continue to serve, and indicate the years of service on each

. __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. List any civic organizations within Blount County of which you are an active participant: