2. Thank you for your interest in serving on a Board/Commission for the City of La Vista.

   Please complete the following information for the City's review.

   Please note: All information provided by you on this form, except your driver's license number, is subject to Nebraska Open Public Record Statutes. As public information, it may be requested by news media representatives or discussed in public meetings.
   

   A Criminal Background check will be required for all board and commission applicants.
   
   
4. 
   
6. Please indicate your first preference*
   -- Select One --Select OneBoard of Adjustment/AppealsBoard of HealthCitizen Advisory Review CommitteeCivil Service CommissionLibrary Advisory BoardPark & Recreation Advisory CommitteePersonnel BoardPlanning Commission
8. Please indicate your second choice
   -- Select One --Select OneNoneBoard of Adjustment/AppealsBoard of HealthCitizen Advisory Review CommitteeCivil Service CommissionLibrary Advisory BoardPark & Recreation Advisory CommitteePersonnel BoardPlanning Commission
10. Please indicate your third choice
    -- Select One --Select OneNoneBoard of Adjustment/AppealsBoard of HealthCitizen Advisory Review CommitteeCivil Service CommissionLibrary Advisory BoardPark & Recreation Advisory CommitteePersonnel BoardPlanning Commission
12. Please indicate your fourth choice
    -- Select One --Select OneNoneBoard of Adjustment/AppealsBoard of HealthCitizen Advisory Review CommitteeCivil Service CommissionLibrary Advisory BoardPark & Recreation Advisory CommitteePersonnel BoardPlanning Commission
14. 
    
16. Name*
18. Home Address*
20. Home Phone Number*
22. Business Phone Number
24. E-mail Address*
26. Fax Number
28. Number of years you have lived in La Vista*
30. Driver's License #*
32. Occupation*
34. Employer
36. Business Address
38. Education (highest school year, degree, etc.)*
40. Political Party Affiliation (Civil Service Only)
42. Prior Appointed or Elected Offices Held (if any)
44. Present/Past Community Volunteer Activities
46. Why would you like to serve? (Please note, specific interests, experience, and qualifications
    which would make you an effective commission member)*
48. Date*
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

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