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Statement of Interest to Serve

  1. Please list in order of preference the Boards and Commissions for which you would be willing to serve
  2. Any / All Boards / Committees
  3. Note:
    By applying for the above listed Boards and Commissions, I have no known apparent or potential conflict of interest.
  4. (If different)
  5. Do you live within the extraterritorial jurisdiction of a municipality?
    (The extraterritorial jurisdiction is the area just outside the city limits of a municipality)
  6. (This information can be obtained from the Board of Elections at Phone: 252-902-3300)
  7. Educational Background:
  8. Please list all past employers and volunteer experience you have had which may be beneficial in evaluating your qualifications.
  9. Pitt County Citizen Academy Graduate?
  10. How did you become aware of Pitt County volunteer opportunities?
    (Please check the appropriate response)
  11. 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.
  12. 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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  14. This field is not part of the form submission.