Township of Hamilton

"Citizen Leadership Form"

2090 Greenwood Avenue, Room 210

PO Box 00150

Hamilton, New Jersey 08650-0150

Phone: 609-890-3622

The enactment of the "Citizen Service Act" (A2784) on October 19, 2009 has important provisions that affect citizens on local boards. This form is to be completed by any person interested in serving on a municipal authority, board, or comission and submitted to the municipal clerk.

I hereby apply to perform public service on the following municipal authorities, boards, or commissions.

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First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Boards and Commissions Interested in Serving On

City, State, Zip Code

Please list any: education, prior volunteer experience, work related experience, or other civic involvement which could be of use to the authorities, boards, or commissions which you listed above.

All information entered below is personal information which will not be subject to public disclosure

Phone Number

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Address or Location

*The information in this section is considered personal information, and is therefore deemed confidential for the purpose of P.L. 1963, c. 73 (C.47:1A-1 et seq.) and P.L. 2001, C. 404

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