Application for Commission & Committees

2. 
4. Date*
   Date
6. List of Boards, Commissions and Committees*
   -- Select One --Lodging Tax Advisory CommitteeCivic Service CommissionDiversity, Equity, and Inclusion CommissionHistoric Preservation Commission Parks and Arts Commission Rosehill Community Board Long-Range Financial Planning CommitteeSalary CommissionPlanning Commission

   Please select one from the following list. If you would like to apply to more than one Board, Commission or Committee, please complete separate applications.

8. Name*
10. Address*
12. Address Line 2
14. City*
15. State*
16. Zip Code*

18. You must be a resident of Mukilteo to serve on a City Board, Commission or Committee. If you are applying to serve on the Civil Service Commission, State Statues require that you be a U.S. Citizen, have been a resident for at least one year immediately preceding appointment and an elector of Snohomish County. (RCW 41.08 and RCW 41.12.030, and City of Mukilteo Civil Service Commission Rules and Regulations)

20. Telephone

    Please list your home phone number. If you wish to list only a cell phone number, leave this space blank. You must list either a phone or cell phone number. Use format (###) ##-####.

22. Cell Phone *

    Please use format (###) ##-####.

24. Email Address *
26. Length of Residence in Mukilteo (use Y/M format)*

    Please list the number of years/months you have resided in Mukilteo. If you are applying to serve on the Historic Preservation Commission and are not a City resident, type N/A.

28. Please list your job title, duties, formal education, and/or prior experience that relates to this Board, Commission or Committee:*
30. Please list your organizational affiliations that relates to this application:*
32. Describe why you are seeking appointment:*
34. Name of First Reference *

    Please enter the first then last name of your first reference. 

36. Phone Number of First Reference *

    Please enter the phone number of Reference 1. Use format (###) ###-####.

38. Name of Reference 2*

    Please enter the first then last name of your second reference.

40. Phone Number of Reference 2*

    Please enter the phone number of Reference 2. Use format (###) ###-####.

42. Name of Reference 3*

    Please enter the first then last name of your third reference.

44. Phone Number of Reference 3

    Please enter the phone number of Reference #3. Use format (###) ###-####.

    
    

46. General Comments

    Please enter in any additional comments or information you feel is important for consideration of your application.

48. All Boards and Commissions members are provided with a City of Mukilteo email account which is required for use on official City business. Please check the box to confirm you are willing to use a City of Mukilteo email account which will be provided to you upon appointment. *

    1. Confirm
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field