PINE GROVE TOWNSHIP
APPLICATION FOR APPOINTMENT TO BOARDS, COMMISSIONS, COMMITTEES
PLEASE PRINT, COMPLETE AND RETURN TO: PINE GROVE TOWNSHIP
APPOINTMENT APPLICATION
175 OAK GROVE ROAD, PINE GROVE, PA 17963
PLEASE PRINT ALL INFORMATION.
NAME: ___________________________________________________________________________
HOME ADDRESS: ___________________________________________________________________
TELEPHONE NUMBER: ______________________________________________________________
PRESENT OCCUPATION: ____________________________________________________________
CURRENT EMPLOYER'S NAME: _______________________________________________________
EMPLOYER’S ADDRESS: ____________________________________________________________
EMPLOYER'S TELEPHONE: __________________________________________________________
OVER 18 YEARS OF AGE? YES NO
APPOINTMENT APPLYING FOR: ______________________________________________________
*SUMMARY OF QUALIFICATIONS / INTERESTS: __________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
*REASON FOR APPLYING: ____________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
LIST ANY ORGANIZATIONS WHICH YOU ARE AFFILIATED WITH THAT ARE FUNDED BY OR ARE PROVIDED
SERVICE BY PINE GROVE TOWNSHIP GOVERNMENT: __________________________
__________________________________________________________________________________
DATE: _____________________ SIGNATURE: _______________________________________
*Additional information may be attached. kgf5/03