Pitt County Forms Center

2.  
   
   
   

   1717 W. 5th Street Greenville, NC 27834  |  Telephone: (252) 902-2950

   Statement of Interest to Serve
    

4. Please list in order of preference the Boards and Commissions for which you would be willing to serve
6. 1.
7. 2.
9. 3.
10. Any / All Boards / Committees

    1. Check if applicable
12. Note:
    By applying for the above listed Boards and Commissions, I have no known apparent or potential conflict of interest.
14. If you are responding to a specific criteria for a position, please explain further:
16. First Name*
17. Last Name*
19. Date of Birth*
20. Sex
21. Race
23. Residence Address*
25. City*
26. State*
27. Zip Code*
29. Mailing Address
    (If different)
31. City
32. State
33. Zip Code
35. Home Phone Number
36. Work Number
37. Fax Number
39. Employer
41. Job Title
43. Email Address
45. Do you live within the extraterritorial jurisdiction of a municipality?

    1. Yes
    2. No

    (The extraterritorial jurisdiction is the area just outside the city limits of a municipality)
47. Please list your County Commissioner District.
    (This information can be obtained from the Board of Elections at Phone: 252-902-3300)
49. Educational Background:
51. High School Attended
53. Address
55. City
56. State
57. Zip Code
59. College Attended
61. Address
63. City
64. State
65. Zip Code
67. Degree(s) Received
69. Please list any military experience.
71. If you are presently serving as an elected or appointed offical, please explain.
73. Please list all past employers and volunteer experience you have had which may be beneficial in evaluating your qualifications.
75. Work Experience
77. Volunteer Experience
79. Pitt County Citizen Academy Graduate?

    1. Yes
    2. No
81. How did you become aware of Pitt County volunteer opportunities?

    1. Newspaper
    2. Current Pitt County Volunteer
    3. Radio
    4. TV
    5. Other

    (Please check the appropriate response)
83. If other, please explain.
85. If I am appointed to serve on one or more boards, I will agree by signing an Affirmation of Understanding, to attend the required amount of meetings each calendar year and not to exceed unexcused absences by more than 25%, or three (3) meetings in any calendar year.
87. Electronic Signature
88. Date
    Date
90. Please feel free to attach a resume if desired.
92. Note
    When applying for a Pitt County Board or Commission, your application is considered a public record. The Board Appointment policy requires that applications be on file in the Clerk's Office 15 days prior to consideration for appointment.
    
    Interest to Serve forms remain current for two full years. Following that, the applicant may wish to contact the Clerk to the Board's Office for an updated form.
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94. Submit

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