BERNARDS TOWNSHIP “TAP THE TALENT” VOLUNTER FORM

Personal
Information

Last Name   First Name    MI

Home Address   City   State   ZIP

Home Phone:  Work Phone:  Email:  

# Years Resident   Availability: Day   Evening   Daily   Weekly   Monthly

Education &
Professional
Information

Highest Degree  Major 
School    Present Employer 
Position 

Prior
Volunteer
Experience

Have you ever served as a volunteer for Bernards Township?
No Yes, if so please list

Other volunteer experience?
NoYes, if so please list

Agency                                                                    Year/Term


Agency                                                                    Year/Term


Board and
Commission
Interests

Agricultural Advisory
Board of Health
Deer Management Advisory
Environmental Commission
Fire Department
First Aid Squad
Fire Safety Forum
Fire or First Aid (Adminis.)
Flood Mitigation/LEPC
Green Team
Golf Utility
Library Board
Municipal Alliance
Rec, Parks & Pathways
Planning Board
Pool Commission
Sewerage Authority
Special Task Force
Shade Tree Commission
Youth Services Comm.
Zoning Board of Adjustment
Other
  If Other, please specify

Professional
Experience
&
Personal
Interests

Mark your areas of expertise or interest: (E-Experience; I-Interest)

  •   E      I
  • Arts & Culture
  • Beautification
  • Community Development
  • Community Services
  • Computers
  • Crime Prevention
  • Education
  • Environmental
  •   E      I
  • Government
  • Finance
  • Fire & Rescue, First Aid
  • Fund Raising
  • Health Issues
  • Historical
  • Landscaping & Trees
  • Library
  •   E      I
  • Leisure Learning
  • Open Space Preservation
  • Planning & Zoning
  • Recreation & Pool
  • Quality Management
  • Senior Citizens
  • Traffic

HAVE YOU EVER BEEN CONVICTED OF A CRIME, including misdemeanors and summary offenses, which has not been sealed or otherwise cleared from your record? IF YES, EXPLAIN INCLUDING PERIODS OF REHABILITATION. (A yes answer is not an automatic bar to appointment.)

Additional
Information

Please add any information you feel would be helpful


I verify the information provided by me is true and accurate and by submission of this form I am indicating my interest in serving as a Bernards Township volunteer.
Date: 5/22/2012