APPLICATION FOR MEMBER BOARD OF EDUCATION

School District

Name (First, Middle, Last):  	  Address:  	  City/State/Zip Code:  		 Home Phone:  	  Work Phone:  	 Occupation:  	  Current Place of Employment:  	 

Employment History: (List most recent position first)

Dates	Position	Organization	

			

			

Education:

School Name	Major/Course	Dates	Degree	

				

Civic or Professional Organization Memberships:

References:

Name	Address	Phone	

Are you 18 years or older?  F Yes F No
Are you a registered voter in the school district? F Yes  F No
Have you ever been arrested for or convicted of a felony? F Yes  F No
Do you have children of school age?   F Yes   F No
Do your children attend our schools?   F Yes   F No
Is any member of your immediate family an employee of the school system?   F Yes   F No
If yes, whom?  	(name)  	_(position)

 	_  	
Signature of Applicant	Date