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2. Board/Committee/Commission (B/C/C) Application
4. Select the Board, Commission, or Committee applying for*
   -- Select One --Select OneBoard of AssessorsBoard of HealthConservation CommissionPlanning BoardZoning Board of AppealsOther
6. If Other, Which B/C/C are you applying?
8. Personal Information
10. First Name*
11. Middle Name
12. Last Name*
14. Address1
16. City
17. State
18. Zip
20. Primary Number
21. Alternate Phone
23. Email Address*
25. Are you presently, or have you ever served on a Board, Committees, or Commission in Town of Bridgewater?*

    1. Yes
    2. No
27. If yes, please provide dates of service and Identify B/C/C:
29. Are you Applying for reappointment?

    1. Yes

    1. No
30. If Yes, number of years previously served:
32. How did you hear about this vacancy?

    1. Town Website
    2. BTV
    3. Newspaper
    4. Existing B/C/C member
    5. Other
33. If other How did you hear about this vacancy?
35. Please Attach Resume
    Please Attach Resume in Microsoft Word or PDF Format (.doc,.docx, .pdf)
37. In addition to providing a resume, please detail below experience and skills relevant to the B/C/C to which you are applying. List work/volunteer experience, technical skills or other abilities which will make a positive contribution to the B/C/C.
39. Please be advised that the applicants being considered for appointment to a B/C/C in the Town of Bridgewater, MA may be subject to background investigations and financial disclosure.
    
    I understand that participation in a board or committee is strictly voluntary and is not subject to compensation. I further understand that the Town of Bridgewater does not discriminate its selection process for committee members based on race, color, religion, national origin, disability, gender, age, military status, sexual orientation, or genetic history.
    
    Signing below indicates my understanding of the above disclosures and certifies that the information provided above to me is true and accurate to the best of my ability.
41. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
43. Electronic Signature
44. Date
    Date
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit Submit and Print

* indicates a required field