Hot Springs Arkansas | Agenda Request Form

Welcome to the City of Hot Springs Arkansas : Government at Your Service

Advisory Board, Commission or Committee
First Choice
Second Choice

General Information
Full Legal Name:
City Board District Residency:
Voter Reg. #:
Home Address:
How long have you lived at this address?
Home Phone:
Cell Phone:
Business Name:
Business Address:
Business Phone:
E-Mail Address:

EDUCATION: Please describe your educational background, including the highest level attained and all college degrees, technical training, certifications, etc. that are relevant.


SKILLS AND QUALIFICATIONS: List any specific skills, abilities, and/or qualifiaations that are relevant to the position(s) for which you applied.


REFERENCES: Please provide names and telephone numbers of three (3) references, other than relatives.
1.
2.
3.

REASON FOR APPLYING: Please describe your reason for applying for a position on a citizen board or commision, including any particular goals you have for the board or commission for which you are applying and any unique talents, experiences, or interests that would help make you an excellent member.


CRIMINAL HISTORY: Have you ever been convicted of a felony? If so, please provide the nature of the charge, sentence received, and the date of same.


EMPLOYMENT: Please briefly describe your past two (2) places of employment, including job title(s), dates of employment, location of job, typical duties, etc.
1. Current Employer:
2. Previous Employer:

COMMUNITY SERVICE ACTIVITIES: Please describe your community service activities:


COMMITTEE SERVICE: Please list any other city, county, or state advisory committees on which you serve.


FAMILY RELATIONSHIPS: Do you have any family members who are currently or were within the past two (2) years employed by the City of Hot Springs? If so, please list names, relationship with you, and the department in which they were employed.


BUSINESS RELATIONSHIPS: Do you conduct any business with the City of Hot Springs? If so, please explain the nature of that business.


- I certify that the above information is true and accurate to best of my knowledge.

Note: To be eligible for nomination for a board, commission or committee, you must be a registered voter residing within the city limits and, in some cases, reside within a specific board district of Hot Springs.

PLEASE RETURN THIS FORM TO: Office of the City Manager, to the attention of Margaret Parris, City of Hot Springs, P.O. Box 700, Hot Springs, Arkansas, 71902, or you may fax this form to (501) 321-6814. If you have any questions, please call (501) 321-6811. THANK YOU FOR VOLUNTEERING TO SERVE YOUR COMMUNITY!