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CITIZEN PROFILE FOR APPOINTMENT VOLUNTEER BOARDS, COMMITTEES, COMMISSIONS, & AUTHORITIES Title: Name: Date: Address: Phone: Email: Registered Voter: □Yes □No I AM INTERESTED IN SERVING ON THE FOLLOWING: □Airport Authority □Board of Elections and Voter Registration □Board of Equalization □Board of Health □Board of Assessors □Department of Family and Children Services (DFCS) Board □Development Authority □Gordon County Public Facilities Authority □Gordon-Floyd Development Authority □Highland Rivers Community Service Board □Historic Preservation Commission □Historical Society □Hospital Authority □Library Board □Limestone Valley Resource, Conservation, and Development Agency □Northwest Georgia Region I Emergency Medical Services Coordinating Council □Northwest Georgia Regional Commission □Planning & Zoning Commission □Region I Behavioral Health and Developmental Disabilities Advisory Council □Tallatoona Community Action Partnership Place of Employment: Title: Education: □High School □Two-Year Degree □Four-Year Degree □Post Graduate Degree Previous Community Involvement: Please return completed form to: County Clerk - Gordon County Board of Commissioners P.O. Box 580 Calhoun, Georgia 30701 [EMAIL REDACTED] ---PAGE BREAK--- CITIZEN PROFILE FOR APPOINTMENT VOLUNTEER BOARDS, COMMITTEES, COMMISSIONS, & AUTHORITIES Applicant Name: Are you at least 18 years of age? □Yes □No Are you a resident of Gordon County? □Yes □No Have you ever been convicted of a felony? □Yes □No Are you willing to attend training relative to the responsibilities of the Board Membership, as provided by Gordon County? □Yes □No Please summarize any prior experience you possess which would be applicable to the appointment you are requesting: Please summarize why you wish to serve in the appointment you are requesting: Please return completed form to: County Clerk - Gordon County Board of Commissioners P.O. Box 580 Calhoun, Georgia 30701 [EMAIL REDACTED]