Citizen Committee Application for Appointment

The City of Gastonia appreciates your interest in serving on a committee and requests that you complete the following application. This application requests general information based on your interest in applying for a committee for the City of Gastonia.

Primary Phone

Secondary Phone

Preferred method of Contact (check all that apply)

Primary Phone

Secondary Phone

Do you reside within the City Limits of Gastonia?

Yes

Length of residence in Gastonia

Years *

Months *

In order to consider this application and provide balance and diversity to the various Boards, the City of Gastonia requests that the following information be voluntarily provided:

Gender

Male

Female

Race

African American

White

Hispanic

Asian

Native American

Other

Occupation

Questionnaire

Why do you want to serve on this committee?

Why do you think you would be an asset to this committee?

What do you feel are your qualifications for serving on the indicated committee(s)?

What areas of concern would you like to see the committee address?

Prior Public Service

Board/Committee/Civic: (Please include starting/ending dates of service)

Additional Information

Additional Comments:

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

If appointed, I pledge to comply with the following ethics guidelines for boards and committees as adopted by the City of Gastonia. Members of boards and committees shall not discuss, advocate, or vote on any matters in which they have a conflict of interest or an interest which reasonably might appear to be in conflict with the concept of fairness in dealing with public business. A conflict of interest or potential conflict occurs if a member has a separate, private, or monetary interest, either direct or indirect, in any issue or transaction under consideration. Any member who violates this provision may be subject to removal from the board. If the board or committee member believes he/she has a conflict of interest, then the member should ask the board or committee to be excused from voting. The board or committee should then vote on the question on whether or not to excuse the member making the request. In cases where the individual member or the board or committee established a conflict of interest, then the board or committee shall remove themselves from the voting area. Any board or committee member may seek the counsel of the City Attorney on questions regarding the interpretation of these ethics guidelines or other conflict of interest matters. The interpretation may include a recommendation on whether or not the board or committee should excuse himself/herself from voting. The board or committee may request the City Attorney to respond in writing.