2. 
4. Application for Consideration of Appointment Kerrville-Kerr County Joint Animal Services Committee
6. Is this a New Application or a Re-appoinment Application?*

   1. New Application
   2. Re-appointment Application
8. Personal Information
10. Personal Information

    1. Mr.
    2. Dr.
    3. Ms.
    4. Mrs.
    5. Other
12. First Name*
13. Last Name*
15. Address:*
17. City*
18. State*
19. Zip*
21. Mailing Address: (if different)
23. City
24. State
25. Zip
27. Phone Number (Home)
28. Phone Number (Business)
30. Fax Number (Home)
31. Fax Number (Business)
33. Email Address*
35. Are you a qualified voter in the city of Kerrville?

    1. Yes
    2. No
37. Do you live inside the city limits of Kerrville? *

    1. Yes
    2. No
39. How Long?
41. Employment
43. Employer Name:
45. Employer Address:
47. Occupation:
49. Business Address:
51. City
52. State
53. Zip
55. To the best of your knowledge, are you employed by, or a member of, any entity (business or non-profit) with proposals, programs, requests, businesses, applications, licenses or any other matters which may come before a board or commission for review, funding, support, or approval during the next two years?

    1. Yes
    2. No
57. If yes, please list the name of entity and interest:
59. Education and Experience
61. Volunteer Experience/Community Service:
63. Have you been a member of a City of Kerrville commission, board or committee?

    1. Yes
    2. No
65. If yes, please specify Board/Commission & Dates of Service
67. To the best of your knowledge, are you employed by, or a member of, any entity (business or non-profit) with proposals, programs, requests, businesses, applications, licenses or any other matters which may come before this board for review, funding, support, or approval during the next two years?

    1. Yes
    2. No
69. If yes, list entity and interest:
71. What experiences qualify you to serve on the Kerrville-Kerr County Joint Animal Services Committee:*
73. Please list Animal Services Experience:*
75. What do you hope to accomplish by serving?*
77. Please provide any additional information you believe would be useful in considering your application.
79. Certification*

    I am not employed by the City of Kerrville. If appointed, I will notify the City of Kerrville of any changes in my residence or business, or of any other relevant changes that would affect my appointment. I will also notify the City if any potential conflicts of interest arise. I recognize that my appointment requires my regular attendance and participation at all scheduled meetings. Failure to do so may result in my removal. I am willing to make this commitment of time and effort. I understand and acknowledge that by selecting the 'I Agree' option below, I hereby certify that all information in this application is complete, truthful and accurate to the best of my knowledge.

    1. I agree
    2. I do not agree
81. First Name
82. Last Name
84. Date
    Date
86. Note:
    When filed at city hall, this will become a public document that may be disclosed per the Texas Public Information Act.
Leave This Blank:


88. 1. Receive an email copy of this form.
89. Email address

    This field is not part of the form submission.

90. Submit Submit and Print

* indicates a required field