Boards and Commissions Application

Thank you for your interest in serving on a Washington County appointed board, committee or commission.  Please take a moment to provide the information below.

NOTE: by submitting this form you are affirming that all the information is true to the best of your knowledge and that you understand that any misstatement of fact or misrepresentation of credential may result in this application being disqualified from further consideration or, subsequent to my appointment to a board/committee/commission, may result in dismissal.  Information you provide on this application may become part of the public record.

Commissioner Look up

 

Date:   mm/dd/yy


Name:

E-mail:

1. Please list in order of preference the boards, committees and commissions on which you would like to serve:

2. Are you a resident of Washington County?  

3. Are you employed in Washington County?    

4. County Commissioner District you reside in? (If you don't know go to "Commissioner Look Up" link above.

 5. Please list the Washington County boards, committees or commissions on which you are currently serving or have previously served ( including the dates of your terms).

6. What days & times are you available for meetings?

 
7. What are your reasons for wanting to serve on an appointed board, committee or commission?


8. What education, work experience, volunteer experience or life experience would you bring to your service on a county board or committee?


9. Please describe your understanding of the major concerns and issues facing the board, committee or commission on which you wish to serve.

 
10. Please list any potential conflicts of interest between your public and private service that might result from your appointment to any of the boards, committees or commissions you listed in question 1.


11. Please list the name, address and telephone number of two people who we may contact as references:


12. How did you hear about this board or commission?

Home or mailing address:    


Day phone:
    

Evening Phone:
   

Fax:

 To ensure your application is considered, be sure to:

1)     Fill out this application completely and submit by the application deadline 
2)     E-mail, mail or fax your resume to the County Administrative Office (optional)


County Administrative Office
155 North First Avenue, Suite 300          
Hillsboro, Oregon  97124
Phone: (503) 846-8685          
Fax: (503) 846-4545 
E-mail: cao@co.washington.or.us  

The application process for positions on certain boards and committees may require an interview or other screening process. Applicants to the Aging & Veterans' Services Advisory Council are asked to complete a Supplementary Application.  For a supplemental application, additional information, or help with this application please call (503) 846-3081.  

As an appointed member of a Washington County board or commission, please be aware that you are considered a public official and subject to Oregon Ethics law limitations on acceptance of gifts, food/drink, travel, and entertainment worth more than $50 per calendar year from any source with an administrative or policy interest in your board or commission. If you are appointed to the Planning Commission, you will also be required to complete an annual form with the Oregon Ethics Commission during your term of service. Please refer to the Oregon Ethics Commission website for more information about ethics requirements for public officials: http://cms.oregon.gov/ogec/pages/index.aspx