Board Member Application

City of Hackensack Board/Committee Application

NAME

HOME ADDRESS

Address Line 1

Address Line 2

City

State

Zip Code

Country

PHONE

E-MAIL

Do you reside within the City of Hackensack?

Yes

Are you 18 years of age or older?

Yes

EXPERIENCE & CIVIC ACTIVITIES

EDUCATIONAL HISTORY/DEGREES EARNED

BOARD, COMMITTEE, OR COMMISSION WHICH YOU WOULD LIKE TO BE CONSIDERED

STATEMENT OF INTEREST

PLEASE LIST ANY CONFLICTS YOU MAY HAVE IF CHOSEN TO SERVE

Have you ever been convicted of a crime?

Yes

If YES, Please explain:

APPLICANT SIGNATURE

Sign Here

DATE