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Citizen Leadership Form

  1. Contact Information - Not Subject To Public Disclosure
  2. I am Interested In Serving On The Following Board(s) (Please Select up to Three)
  3. 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.

  4. *Please provide an updated resume which includes your education, licenses and/or certificates, prior volunteer experience, work-related experience or other civic involvement, which could be of use or is pertinent to the authorities, boards, advisory boards or commissions which you have selected.

    ALL APPLICANTS MUST BE BONA FIDE, FULL-TIME RESIDENTS OF JACKSON TOWNSHIP



  5. 3) Do you currently use social media?
  6. 5) Have you declared bankruptcy in the last 3 years?
  7. 6) Have you ever been arrested or convicted of a crime, or violation of any municipal ordinance in the Township of Jackson or any other municipality, other than traffic offenses?
  8. 7) Are you currently the subject of any outstanding warrant(s)?
  9. The undersigned makes the above statements to induce the Township of Jackson to appoint the applicant herein to perform public service on a municipal authority, board, advisory board, or commission. I certify the information contained in this application to be true and correct. I understand that any misrepresentation, falsification, or omission of any facts called for on this form may disqualify me from a volunteer position on a board or commission in Jackson Township.



  10. 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.

  11. Leave This Blank:

  12. This field is not part of the form submission.