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Online Application for Citizen Boards and Committees

Name:

Address:

Address Line 2:

City or Town:

State or Province:

Zip or Postal Code:

Phone:

Fax:

Email:

List the name of each Board, Committee or Volunteer Opportunity on which you are willing to serve (in order of preference).
1st Choice*

2nd Choice

3rd Choice

4th Choice

How long have you been a resident of Fairborn?*

List the names, dates of service and any offices held (i.e. Chairperson) of all City or related Boards or Committees of which you have been or are presently a member of below.*

The City of Fairborn conducts background checks on all of its volunteers. A valid driver's license or state ID is necessary to process the application. Are you willing to authorize the Fairborn Police Department to conduct a local background check?*

Yes 
No 

Driver's License / State ID Number*

Have you every been convicted of a crime (excluding minor traffic offenses)?*
Yes 
No 

If filling a vacancy on a board or committee, please indicate how you heard about it.
Government Access Channel 5    Newspaper    Utility Bill    City Newsletter    Facebook / Twitter    Website    Other 

Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
I agree. 

Electronic Signature*

Date*


     

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estimated population

commercial land available

1950

year incorporated

median home value