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Step One

PDF Boards & Commissions Application (Optional)
Print Boards & Commissions Application (PDF)
If you would like to complete and submit a hard copy of this application, please click the link to download the PDF version of this application and submit to the City Secretary's Office.
GENERAL INFORMATION
First Name*
Last Name*
Business Address
Optional
Mailing Address*
City*
State*
Zip Code*
Home Phone*
Cell Phone*
Business Phone
Fax Number
Email Address*
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Step Two

DESIRED BOARD/COMMISSION/COMMITTEE POSITION
Length of Time lived in Balch Springs*
At This Address*
Voter Registration #*
Do you have any delinquent Taxes, Utilities or other Assessments owed to the City?*
1. Yes
2. No
Do you have any pending Claims, Litigation against the City?*
1. Yes
2. No
Do you have any adversary party to a pending litigation against the City?*
1. Yes
2. No
Are you an employee of a business associate of either adversary party or a representative of an adversary party, or have a pecuniary interest in any pending litigation or claim, other than an eminent domain proceeding?*
1. Yes
2. No
Please indicate which boards/commissions you would like to participate in, ranking from 1 to 3, where 1 is the Most Desired and 3 being the Least Desired.
(#1) Most Desired Board/Commission*
(#2) Desired Board/Commission*
(#3) Least Desired Board/Commission*
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Step Three

PROFESSIONAL/OCCUPATIONAL INFORMATION
Do you currently serve on any other city Boards/Commission/Committees?*
1. Yes
2. No
If "Yes," please list the other Boards/Commissions/Committees*
Why are you interested in serving on a city Board/Commission/Committee?*
Do you feel you can commit the time serve effectively, should you be elected to serve?*
What do you consider to be the top three (3) issues affecting the City of Balch Springs?*
What is your vision for the future of Balch Springs*
Briefly state your overall mission and goals for the City of Balch Springs*
Institution/School*
Year*
Diploma/Degree*
Current/Previous Employer*
If Unemployed or Retired, please state your previous employment information.
Position*
Dates*
Professional Licenses
Professional Associations/Memberships
Civic/Volunteer Organization & Activities
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Step Four

ELECTRONIC SIGNATURE
I hereby affirm that all the information provided within this application is true and accurate to the best of my knowledge, and understand that any deliberate falsifications, misrepresentations, or omissions of fact may be grounds for rejection of my application from subsequent appointment
I understand that per Section 2-186(b)(3) of the City's Code of Ordinances, to be eligible to serve on a Board / Commission / Committee, a member may not have been convicted of a felony or crime involving theft or criminal offense considered by the City Council to be a disqualification. Therefore, as part of my application process, I understand and agree that the City is required to conduct a criminal background check on all applicants in order to determine eligibility.
I understand that if I should be appointed to a Board / Commission / Committee, I will be expected to participate actively in the business of the respective Board / Commission / Committee. I also understand that I will be expected to become familiar with relevant City Ordinances and review all material relating to decisions to be made and that I may abstain only for causes.
I agree to adhere to the attendance requirements of said Board / Commission / Committee
I agree to contact the City Secretary’s Office in the event that there are any changes in my information, as submitted on this application.
I understand that, should a situation arise during my term in said Board / Commission / Committee where I have a prohibited substantial interest, either direct or indirect, and such matters come before said Board / Commission / Committee, I understand that I will need to abstain from any discussion or vote on the matter.
I understand that, upon submission to the City Secretary's Office, this application becomes the property of the City and the City reserves the right to accept or reject this application.
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) you have read and understand the above terms 2) your application will not be signed in the sense of a traditional paper document, 3) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 4) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
Date*
Date
Date

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

This field is not part of the form submission.
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