HomeMy Public PortalAboutCommittee ApplicationFINAL Select Bd Appt Policy; version Oct. 28
Appendix B
Town of Brewster
SELECT BOARD COMMITTEE APPOINTMENT APPLICATION
APPLICANT DIRECTIONS:
Thank you for your interest in serving Brewster. The Town aims to match applicants
with committee service best aligned to your skills and interests as well as the
committee’s needs.
The Town may consider the information in this application, any supplemental
information, and any other publicly available information. An appointment to any
committee, board or commission is at the discretion of the Select Board.
Please complete this form online, or on paper, and submit a résumé if desired to
Erika Mawn, Town Administrator’s Executive Assistant:
o Email: EMawn@Brewster-MA.gov
o Mail: Erika Mawn, 2198 Main St., Brewster, MA 02631, or
o In person: Town Administrator’s Office or drop-box outside Town Hall.
After your application materials are received, you’ll be contacted regarding next
steps. Vacancies will be filled by applicants deemed best qualified to serve in a
particular capacity, which discretion lies solely with the appointing authority.
Submitting this form does not guarantee appointment.
1. Applicant name:
2. Address:
3. Phone Numbers: Home: Cell:
4. Email:
5. This is an application for: Full member status Alternate status
6. Are you a full-time Brewster resident? Yes No
7. Years you’ve lived in Brewster:
8. Are you registered to vote in Brewster? Yes No
9. Committees you are interested in serving on in order of preference:
a.
b.
c.
NOTE: You may attach a résumé or CV instead of completing items 10-14.
FINAL Select Bd Appt Policy; version Oct. 28
10. EDUCATION. List schools attended, degrees/diplomas/certificates received,
and date of completion.
Name of School
Degree/Diplomas
Certificates
Date of
Completion
11. OCCUPATION: ______________________________________________________
Active Retired Not currently working
12. EMPLOYMENT EXPERIENCE. List employers, job titles and dates of
employment for at least previous 3 years.
Name of Employer Job Title Dates of
Employment
13. GOVERNMENT POSITIONS. List any Town of Brewster or other government
volunteer, elected, or appointed positions you now hold or have held.
14. COMMUNITY ACTIVITIES. List all civic, non-profit, or other organizations that
you belong to or have belonged to in the previous 5 years:
a. Organizations and dates:
15. GOALS: Please explain why you’d like to serve on a particular committee.
16. EXPERIENCE & SKILLS: Please list any experience, achievements, skills, or
interests you have that would assist you to serve effectively on the committee
you wish to serve on.
17. TOWN EMPLOYMENT: Are you or any member of your immediate family
employed by or receiving financial consideration from the Town of Brewster?
Yes No
18. CONFLICTS OF INTEREST. Do any of your activities or relationships present
the possibility or probability of a conflict of interest if you are appointed?(Does
not automatically disqualify but may need to be disclosed) Yes No
19. LOCAL REFERENCES: Please provide the names and contact information for
references (Brewster residents preferred):
20. ADDITIONAL INFORMATION. Please add any additional information you’d like.
a. Name:
Address:
Phone:
Email:
Relationship to you:
b. Name:
Address:
Phone:
Email:
Relationship to you:
FINAL Select Bd Appt Policy; version Oct. 28
20. SIGNATURE. By signing below, you state that you understand and agree.
My completion of this form does not guarantee my appointment and my
application will be kept on file for two (2) years.
If appointed to a position, I will be considered a Municipal Employee under
MGL Ch. 268A and will be subject to:
Massachusetts Conflict of Interest Law, MGL Ch. 268A;
Massachusetts Financial Disclosure Law, MGL Ch. 268B;
Massachusetts Open Meeting Law, MGL Ch. 30A, Sections 18-25, and the
implementing regulations, 940 CMR 29.00;
Massachusetts Public Records Law, MGL Ch. 66, and the implementing
regulations, 950 CMR 32.00;
Massachusetts Campaign Finance Law, MGL Ch. 55; and
Brewster Charter, when in force, and Town bylaws, and all other applicable
federal, state, and local laws or regulations.
If appointed, I must be sworn in by the Town Clerk before serving, and I will
complete State Conflict of Interest training after appointment, as well as
any other certifications required by law.
When submitted, I understand that this form becomes a public document.
Signature: Date: