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City of Lewiston Application for Appointment to City Board/Commission/Committee Full Street Mailing Address (if Telephone Number: (daytime) (evening) Email Address: Length of time as a Lewiston Resident: Council Ward: I wish to be considered for appointment to the: (Name of Board/Commission/Committee) Check one or both: Membership Status Associate Membership Status Educational Background: Employment History: Community Service: Please note any prior experience, knowledge or abilities that you have which would contribute to the activities of the Board/Commission/Committee: Date: Signature: Thank you for your interest in serving the City of Lewiston. Please return form to: City Clerk’s Office, 27 Pine Street, Lewiston, ME 04240-7297 ---PAGE BREAK--- FOR USE BY CITY CLERK’S DEPARTMENT: Date application received: Received by: Application submitted to: Mayor’s Office Council President other Date application submitted to above office: Date appointed by Mayor/Council: Date applicant notified by City Clerk’s Office: Date applicant sworn in: Term to begin: Term to expire: Length of term: If filling a vacancy, please note: If no openings available at time of application, please note: The City of Lewiston does not discriminate against or exclude individuals from it’s municipal facilities and/or in the delivery of it’s programs, activities and services based on the individual person's ethnic origin, color, religion, gender, sexual orientation, age, physical or mental disability, veteran status, or limited English speaking ability. For more information about this Policy, contact or call Compliance Officer Mike Paradis at 207- 513-3003, ext.3412 (TTY) 513-3007, or email [EMAIL REDACTED].