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CITY OF SALEM, MASSACHUSETTS Kimberley Driscoll Mayor Application for Appointment to City Board or Commission For a complete list of City boards visit www.salem.com/boards. Please send this form, along with a current resume, to [EMAIL REDACTED] or mail to: Mayor’s Office, City Hall, 93 Washington Street, Salem MA 01970. Name: Address: Email: Daytime Phone: Evening Phone: Current occupation: Board or commission in which you are interested: Why are you interested in serving on this board or commission? In addition to the experience listed in your attached resume, what specific skills or expertise do you believe you can bring to this board or commission? If you are currently serving on any other City boards, please indicate which: Signature: Date: