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Citizen Board Application Form

  1. Please check a box below to indicate which Board you are submitting this application for:*

  2. Are you currently serving on a County Board(s)?*

  3. Are you a resident of the County?*

  4. What District do you live in?*

  5. Do you hold a public office?*

  6. Are you employed by Camden County?*

  7. Have you been convicted of a misdemeanor or felony, excluding civil traffic infractions? (Note: A DUI and/or revoked license are NOT "civil traffic infractions" and must be reported.)*

  8. Do you have any potential conflicts of interest that may arise from time to time if you serve on one of these boards? (A conflict of interest would be anything that inures to your benefit, your employer's benefit, or a member of your family's benefit. Note: Having a potential conflict of interest does not necessarily exclude you from serving on a board.)

  9. I hereby declare that the information provided by me in this application is true, correct, and complete to the best of my knowledge. I understand that, if chosen, any misstatement or omission of fact on this application shall be considered cause for ineligibility for appointment. Applicants are considered for all appointments without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or disability.

  10. Leave This Blank:

  11. This field is not part of the form submission.