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2. First Name*
3. Middle Name/Initial
4. Last Name*
5. Suffix
7. Preferred Name/Nickname
8. Email Address*
10. Address*
12. City*
13. State*
14. Zip Code*
16. Preferred Phone Number*
17. Preferred Phone Type*

    1. Mobile

    1. Home
19. Alternate Phone Number
20. Alternate Phone Type

    1. Mobile

    1. Home
22. District of Residence*

    1. 1st District - West Point
    2. 2nd District - Courthouse
    3. 3rd District - Aylett

    1. 4th District - Manquin
    2. 5th District - Mangohick
23. How long have you lived in King William County?*
27. Employer
28. Employer Phone Number
30. Employer Address Including City, State, Zip
32. Education - Diploma/Degree(s)/Certification(s)
33. Education - School(s) Attended
35. Civic Activities (include other County Boards/Commissions/Committees))
36. Memberships in Fraternal, Business, Church, or Social Organizations (include offices held)
40. Boards/Commissions/Committees

    Please indicate your top three choices for the Boards/Commissions/Committees on which you'd like to serve. At least one choice is required (1st Choice).

42. 1st Choice*
    -- Select One --Building Code Appeals (BCA)Board of Zoning Appeals (BZA)Economic Development Authority (EDA)Finance BoardHistoric Preservation & Architectural Review Board (HPARB)Planning Commission (PC)Recreation Commission (RC)Social Services Advisory BoardVA250 Planning CommitteeWetlands Board
43. 2nd Choice
    -- Select One --Building Code Appeals (BCA)Board of Zoning Appeals (BZA)Economic Development Authority (EDA)Finance BoardHistoric Preservation & Architectural Review Board (HPARB)Planning Commission (PC)Recreation Commission (RC)Social Services Advisory BoardVA250 Planning CommitteeWetlands Board
44. 3rd Choice
    -- Select One --Building Code Appeals (BCA)Board of Zoning Appeals (BZA)Economic Development Authority (EDA)Finance BoardHistoric Preservation & Architectural Review Board (HPARB)Planning Commission (PC)Recreation Commission (RC)Social Services Advisory BoardVA250 Planning CommitteeWetlands Board
48. Thank you for your interest!

    Your application will be kept on file for two (2) years. You will be notified if you are selected to serve on a Board/Commission/Committee.

    Please submit any inquiries to bos.clerk@kwc.gov

    
    

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