CBJ Board Application

Interested in serving on a CBJ Board, Committee or Commission, please fill out and submit the below application. Applications are kept on file for one year from time of submission and you do not have to wait for a vacancy on a board/committee/commission to apply; the Clerk’s Office will reach out to applicants as vacancies arise. Please be aware that all information you provide on this application is open to public review and disclosure pursuant to the Alaska Public Records Act AS 40.25.110 & CBJ Code 01.70

NOTE: To save a copy of your application, right click on the application form and print a copy or PDF for your records prior to hitting ‘Submit’ or contact the Clerk’s Office to have a copy emailed to you

Name(Required)

First Last

Residence Address(Required)

Street Address City State ZIP Code

Mailing Address(Required)

Street Address City State ZIP Code

Primary Phone(Required)

Secondary Phone

Email(Required)

Board, Commission, Committee(Required)

Provide Name of Board/Commission/Committee(Required)

Current of Prior Experience on CBJ Boards/Commissions/Committees(Required)

List any current or past CBJ boards/commissions/committees you have served on, include years of service when possible.

Reasons for Wanting to Serve(Required)

Experience/Professional Expertise/Education

Please provide dates of education and/or experience as it pertains to the board/committee/commission you are applying for

Civic Activities, Memberships or Non-profits Involved With

List any groups or organizations you are involved with that may relate to the board/committee/commission you are applying for (list dates when possible)

Meeting Schedule and Attendance

For the board/committee/commission you are applying for, are you aware of the meeting schedule/how to participate and available to attend regularly scheduled meetings? Appointed members are expected to attend all meetings. A member who misses more than 3 consecutive meetings shall tender their resignation to the board/committee chair per Resolution 2686 - Vacancies Section

Date of Birth

Date of Birth is Optional unless applying for Commission on Aging or Youth Activities Board age specific seats.

Ethnicity

CBJ strives within the make-up of its boards/committees/commissions to reflect the rich cultural diversity of Juneau residents.

Gender

CBJ strives for equity and inclusivity within the make-up of its boards/committees/commissions

Acknowledgement/Certification(Required)

In order to submit this application, please read and agree to the following statement: * By signing/e-signing this document, I understand that this is a volunteer position appointed by the City and Borough of Juneau Assembly and requires regular attendance at meetings. I further understand that this application is public information, and the merits of my appointment may be discussed at a public forum. In addition, my name may be published in a newspaper or other media. I agree that if I am appointed to serve on a board or commission, I will follow all the laws, procedures, and practices associated with the service of a CBJ boardmember. I certify that the information in this application is true and accurate.

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