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Public Service Application

  1. Board(s) or Committee(s) Selection*


    Please use the options below to name the board(s) or committee(s) in which you would like to apply to serve.

  2. Personal Information

  3. Background

  4. Enter highest grade completed or hours earned.

  5. Please include: Organization name, level of service (city, county, state, federal), Dates of service, position (chair, president, member, etc.)

  6. Please list

  7. Have you ever been hired for a position with the City?*

  8. Appointment Qualifications

  9. Are you qualified to vote in a City of Brownsville election?

  10. Are you a City of Brownsville resident?

  11. Have you ever represented any other private person, group or entity for compensation before the City Council or any department, commission, board, or committee of the City within the last three years?

  12. Do you or your spouse, or your employer have any financial interest, direct or indirect, in any contract with the City (including serving as an Administrative Aid to a Council member?)

  13. Do either you, your spouse, or your employer have any financial interest, directly or indirectly, in the sale to the City of any land, materials, supplies or service?

  14. Do you have any litigation pending or completed within the last 12 months, either personally or professionally, that would affect your ability to fulfill the functions of the board or commission, if selected?

  15. Have you ever been convicted of violating any federal, state, or municipal law, regulation, or ordinance?

  16. Are you related to any city commissioners or the mayor?

  17. CONSENT FOR CITY TO CONDUCT A SEARCH OF CRIMINAL HISTORY RECORDS AND RELEASE OF PUBLIC INFORMATION.

    I hereby state that all of the information in this application for appointment is true and correct. I further request, as a part of my application, that all law enforcement officials and criminal justice agencies release any criminal history records concerning me to the Office of the City Secretary of the City of Brownsville in order that qualifications may be checked. I understand that if any member of the public makes a request for information included in this application for appointment, most of the information must be disclosed under the Public Information Act. I understand that the City of Brownsville will attempt to maintain the confidentiality of highly private matters by seeking an Attorney General’s opinion in accordance with the Public Information Act. I understand that it may not be legally possible to maintain the confidentiality of such information, and I hereby release the City of Brownsville, and its agents, employees, and officers, from any and all liability whatsoever if the information must be released pursuant to the Public Information Act or any other law requiring its release.

  18. I have read and understand the guidelines set out this applicaiton. The foregoing statements are true, accurate, and complete: and I agree that any misrepresentation or ommission of facts may result in my disqualification for appointment.
    NOTE: All information provided herein, or pursuant hereto, is considered public record upon receipt.

  19. I agree

  20. Electronic Signature

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) 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 3) you may still be required to provide a traditional signature at a later date.

  21. Leave This Blank:

  22. This field is not part of the form submission.