Boards & Commissions Application Form

Boards & Commissions Application Form

We appreciate your willingness to volunteer to serve on a board or commission at the City of Danville. Your talents and abilities are valuable assets to our city government. For more information about the appointment process, please reach out to the Clerk of Council Office at 434-797-8928.
I would like to apply for the following:*
Applicant Name*

First NameLast Name
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have a mailing address that is different from the address shown above?

YesNo
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Place of Birth
*Some Boards or Commissions do not require city residency, but may require business involvement within the city of Danville. If this is applicable, please be sure to fill out the following business questions.
Business Name and Address
Business Phone Number
Please enter a valid phone number.
Occupation
Length of Residency in Danville*
Years
Are you a registered voter?*

YesNo
Education (only list names of schools where you graduated)
Civic Activities
Are you currently serving on other City of Danville Boards, Commissions, or Committees?*

YesNo
Which?
Have you served on a Board, Commission, or Committee before?*

YesNo
Which?
Do you have a valid Virginia driver's license?*

YesNo
Please explain.
Are your accounts current with the City of Danville (taxes, utilities, etc.)?*

YesNo
Please explain.
References (people who are not relatives); three are required*
Tell us more about yourself
Time available, interests, unique qualifications, etc.
Criminal Record and Child Protective Services Information

Provide information regarding the nature of the convictions and approximate date(s) of "Yes" answers.
Except for minor traffic violations, have you been convicted of any violation of law?*

YesNo
Describe
Have you ever been convicted of a felony?*

YesNo
Describe
Have you ever been convicted of a misdemeanor involving moral turpitude (any offense involving lying, stealing, or cheating) since your 18th birthday?*

YesNo
Describe
Are there any criminal charges or proceedings pending against you?*

YesNo
Describe
I hereby certify that the information provided on this application is correct to the best of my knowledge and belief. I also hereby authorize the officials of the Central Criminal Records Exchange, law enforcement officials or officers, the Commissioner of the Department of Motor Vehicles, or any officer or employee of the Department of Motor Vehicles, the Commissioner of the Revenue of the City of Danville, Virginia, the Treasurer of the City of Danville, Virginia, the Director of Central Collections for the City of Danville, Virginia and/or any other person or official to provide any information relating to my record with respect to convictions for traffic violations or other offenses involving the operation of a motor vehicle, felony, or misdemeanor convictions, if any, and/or taxes assessed against me or my property which are delinquent, if any, to the City Clerk, the Council of the City of Danville, Virginia, and/or to any other person designated by the Council to receive such information.
I AM WILLING TO SERVE ON MORE THAN ONE (1) AUTHORITY, BOARD, OR COMMISSION CUNCURRENTLY.

YesNo
Signature*

Clear
NOTE: Successful candidates for the Board of Zoning Appeals, Planning Commission, Utility Commission, IDA, and the Housing Authority are required by State Law to complete a Conflict of Interest Form as a condition of taking office and thereafter annually on January 15.

Please note that some meetings take place during the day and some meetings are televised. For more information on each board, please visit the City’s website, email the City Clerk at sdemasi@danvilleva.gov, or call 434-797-8928.

Danville City Code Section 2-45(a) "Any person appointed by Council to a board or commission who fails to attend seventy-five(75) percent of the regular meetings of said board or commission will be deemed to have resigned from that office."

CONTACT THE CITY CLERK'S OFFICE FOR FURTHER INFORMATION:
TELEPHONE: (434) 797-8928
FACSIMILE: (434) 799-5041
E MAIL: sdemasi@danvilleva.gov

BY SIGNING AND CLICKING "SUBMIT", YOU ARE SENDING AN ELECTRONIC SIGNATURE THAT VERIFIES EVERYTHING IN THIS APPLICATION IS TRUE AND ACCURATE. IF YOU DO NOT WISH TO SUBMIT AN ELECTORNIC SIGNATURE, PLEASE USE THE CANCEL BUTTON TO EXIT THE APPLICATION.
Should be Empty: