CITY OF NEWTON FALLS

COMMISSION/BOARD APPLICATION

                                                                          DATE:  _______________________  

Application for membership on _____________________________________________.                                                                 (Name of Commission or Board) 

 Name:              ____________________________________________________________ 
Address:            ____________________________________________________________ 
                        ____________________________________________________________  

Phone Number:            _________________________________ Home                       
                                  _________________________________ Cell 
                                  _________________________________ Work 

 Are you a qualified elector of the City of Newton Falls __________ yes  __________ no.

 * Civil Service, Planning & Zoning applicants.  Per the Newton Falls City Charter no member shall hold any other office, employment or position with the City.

 Do you hold any other office, employment or position with the City of Newton Falls.

 __________ yes (if so please explain) ________________________________________,

 __________ no

 **Civil Service applicants only:  Article VI, Commissions and Boards, Section I. Civil Service Commission, Paragraph 2; “No member of the Civil Service Commission shall hold any other office or employment with the City and not more than two such members shall be members of the same political party”. 

Please indicate political party ______________________________________________.