BOROUGH OF WASHINGTON
COUNTY OF WARREN, STATE OF NEW JERSEY
CITIZEN INVOLVEMENT APPLICATION

All citizens of the Borough of Washington interested in having their names considered for appointment, by the Borough Council, at such time as a vacancy occurs, on any committee where appointments are made by the Council or on any special committee created by the Council, should fill out this application and return it to the Borough Manager, 100 Belvidere Ave., Washington, New Jersey 07882 . Please note that fields below marked with ** are required.

Name:**                         Telephone: Home:**
                                                                                              Business:  
Address:

E-Mail:**
Re-type E-Mail:**

How long have you resided in Washington Borough?     Years       Months

Educational Level obtained (Check one)
High School Diploma          Some College
Associate Degree               Bachelor's Degree
Master's Degree                 Doctorate Degree

Educational Specialty or Field of Employment

Experience: Company Position Held Years of Service

Civic Involvement:
Organization Position Held Years of Service

Areas of Particular Interest in Local Government: (Check one or more)
Planning & Land Use Control	Finance	Recreation
Education	Fire	Public Works
Solid Waste	Energy Conservation	Public Safety
Emergency Medical Assoc	Community Development	Communications
Sewers & Storm Drains	General Government