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2. First Name*
3. Last Name*
5. Address1*
6. Address2
8. City*
9. State*
10. Zip*
12. Phone Number *
13. Email Address*
17. Employer*
18. Occupation*
20. Experience / Expertise*
22. Employer Address
23. Phone Number
27. Education*
29. Civic Activities & Memberships*
33. Interests*

    Please check the boards for which you are applying.

    1. Board of Zoning Appeals
    2. Economic Development Authority

    1. Parks & Recreation Committee

    1. Planning Commission

    1. Public Art Commission
35. Special Skills or Qualifications*
    Summarize relevant skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports.
36. Reasons for Wanting to Serve*
    Tell us why you'd like to be appointed.
38. Criminal History*
    Have you ever been convicted of a criminal offense other than a minor traffic infraction? If yes, please indicate the type of conviction, the locality in which you were convicted, and the date.
40. Resume
    If you'd like to submit a resume, please upload it here.
41. Cover Letter
    If you'd like to submit a cover letter, upload it here.
43. Applicant Verification*

    By submitting this application, I affirm that the facts set forth in it are true and complete. I further affirm that I have no delinquencies for applicable Town of Ashland or Hanover County taxes and that I am both able and willing to submit a financial disclosure as required by state code prior to being appointed. If appointed, I agree to immediately advise the town manager in the event that I am ever charged with or convicted of any criminal offense other than a minor traffic infraction. I understand that all information on this application is subject to verification and consent to criminal history and sex offender registry background checks conducted by the Town or their designated contractor.

    1. I agree

    1. I do not agree
44. Our Policy
    The Town of Ashland does not discriminate on the basis of race, color, national origin, sex, religion, age, sexual orientation or disability in employment or the provision of services. Your application will be kept on file for two years. Applicants will be considered as vacancies occur. Thank you for applying and your willingness to serve your community.
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46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

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