Backup — original pdf

Backup

The City of Austin, TX Boards & Commissions Application Form Select Language Powered by Translate (https://translate.google.com) First Name * Middle Initial Last Name * * Denotes a required field Profile Preferred Name Email Address * Home Address * City * State * Postal Code * TX Residency and District Information Are you a City of Austin Resident? * Are you, or your employer, a registered lobbyist with the City or have you, or your employer, been registered as a lobbyist with the City Clerk within the past three years? * Primary Phone * Home Home Alternate Phone Cell Phone Home Phone Business Phone Select Your District Click the Image to Enlarge Employer Job Title Interests & Experiences Please tell us about yourself and why you want to serve on a board or commission Why are you interested in serving on a board or commission? Accepted file types: RTF, DOC, DOCX, PDF, TXT, JPG, JPEG, GIF, PNG Upload a Resume Choose file Resume Qualifications Demographics Some boards and commissions require membership to be racially, politically or geographically proportionate to the general public. The following information helps track our recruitment and diversity efforts. Ethnicity Sexual Orientation Gender Date of Birth Disability or Impairment Information Do you have an auditory/hearing disability or impairment? Do you have a visual disability or impairment? Do you have a mobility disability or impairment? Do you have a cognitive disability or impairment? Do you have another disability or impairment you'd like to share? Board Requirements Which Boards would you like to apply for? * ! Please select a Board None selected Some boards have additional requirements for appointees. Additional requirements will appear below as they apply to each board. They may not necessarily exclude a individual from service. Texas Open Records Act City of Austin Officials are able to choose whether or not their home address, home telephone numbers, emergency contact information, social security number, and information that reveals whether they have family members are available to the public on request. The Texas Public Information Act is a State law that requires the City of Austin to disclose this information to anyone who requests it. The only exceptions are for: 1) commissioned peace officers; and 2) Official who file a written request to withhold this information. Officials who are not peace officers and who do not submit such a written request will have this information made available to anyone who requests it. Do you choose to have your home address, home telephone number, emergency contact information, social security number and information that reveals whether you have family members withheld from the public? * Yes No Withdraw (/boards/forms/385/apply/4093155?code=b4d2bad8-cf86-4e2d-960f-f50195232ca6) View as PDF/Print (/boards/forms/385/apply/4093155.pdf?code=b4d2bad8-cf86-4e2d-960f- f50195232ca6&no_redaction=true) Save for later Submit