Village of Lisle Form

2. Application Date:*
   Application Date:
4. Board, Commission, Committee Application
   Thank you for your willingness to serve the Lisle community! Please complete this application for consideration to serve on a Village of Lisle Board, Commission, or Committee.
6. Select the Board, Commission, or Committee applying for*

   1. Board of Fire & Police Commission
   2. Flood Information Committee
   3. Planning & Zoning Commission
   4. Police Pension Fund
   5. Public Art Advisory Committee
   6. Transportation Advisory Committee
   7. Other
8. If you selected 'Other,' please provide your suggestion for a new Board, Commission or Committee.
10. PROFILE
12. First Name*
13. Last Name*
15. Email Address*
17. Street Address*
19. Address Line 2
21. City*
22. State*
23. Zip*
25. Primary Phone *
26. Alternate Phone*
28. Are you a Lisle resident?*

    1. Yes
    2. No
30. If yes, how many years have you lived in Lisle?
32. Are you a Lisle business owner?*

    1. Yes
    2. No
34. If yes, what is the name of your Lisle business?
36. Are you currently serving on a Board, Commission, or Committee?*

    1. Yes
    2. No
38. If yes, please list:
40. Have you served on a Board, Commission, or Committee before?*

    1. Yes
    2. No
42. If yes, please list:
44. Why are you interested in serving on these boards/committee/commission?
46. Please describe any background or professional experiences related to your Board/Commission/Committee appointment request.
48. Current Employer:*
50. Please list any degrees or certifications earned:*
52. Please list any current or previous community/volunteer/civic activities:
54. Do you have any personal or business interest that could create a conflict (either real or perceived) if appointed?*

    1. Yes
    2. No
56. If yes, please explain conflict:
58. Is there anything that would adversely affect public confidence in your appointment or service?*

    1. Yes
    2. No
60. If yes, please explain:
62. Upload a resume (optional)
64. Boards, Commission and Committee Disclaimer
    I certify that the information provided in this application is true and correct to the best of my knowledge. I authorize all persons having information concerning my qualifications to release information to Village representatives and release such persons from all liability for any damages connected with the release of such information. I also release and discharge the Village of Lisle from any claims and damages, losses, liabilities, costs, expenses or any other charges or complaints arising out of the Village's use of any information provided pursuant to this release. I understand that affixing my name in this form is deemed an electronic signature that has the effect of a written signature and will be presumed a valid signature, absent notification otherwise. I hereby acknowledge that this application and information provided herein may constitute a public record under the Illinois Freedom of Information Act, and as such, may be released in accordance with all applicable public record laws.
66. Please check this box after reading the above disclosure statement:*

    1. I agree
68. Please type your name below:*
Leave This Blank:


70. 1. Receive an email copy of this form.
71. Email address

    This field is not part of the form submission.

72. Submit Submit and Print

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