Notice of Public Record

Please be advised that all information contained in this application is part of the City of Fernley’s public record and is available for public review. These positions are limited, in most cases, to residents of the City of Fernley. The City Council makes a conscientious effort to appoint persons who represent all of the various communities within the City of Fernley. Please be advised that certain boards and commissions require filing of financial statements with the Secretary of State or have special requirements. Contact the City Clerk’s office at 775-784-9030 with any questions.

Name:*

Email Address:*

Home Address:*

What ward do you live in?*

Primary Phone:*

How long have you been a resident of the City of Fernley?*

Are you over 18 years of age?*

Yes

No

Are you currently registered to vote in the City of Fernley?*

Employer:*

Job Title:*

Which board would you like to apply for?*

Have you ever been convicted of a felony or misdemeanor other than minor traffic violations?*

Yes

No

If yes, please list conviction dates and nature:*

Interests & Experiences

Education or training relevant to the board or commission to which you are applying:*

Explain briefly why you would like to be appointed to this board or commission.*

Demographics

This section is optional and your responses will not be utilized for appointment. The following information helps track our recruitment and diversity efforts.

Ethnicity

Gender

Date of birth

WAIVER OF NOTICE REQUIRED UNDER NRS 241.033(1) TO ALLOW CITY COUNCIL TO CONSIDER CHARACTER, MISCONDUCT, OR COMPETENCE OF PERSON TO BE APPOINTED TO A BOARD, COMMISSION, OR OTHER PUBLIC BODY FOR THE CITY OF FERNLEY

The City Council for the City of Fernley will be considering on a future posted agenda your appointment to a board, commission or other public body for the City of Fernley. Pursuant to NRS 241.033(1), in order to consider the professional competence of an applicant, notice need be provided to that person of the time and place of the meeting in compliance with such statutory provisions. By agreeing below, it is confirmed that I have been provided notice of the meeting at which my appointment will be considered by City Council. Further, I knowingly and voluntarily am waiving my rights to all written notice requirements under NRS 241.033(1) pertaining to my qualifications, competence, and character to hold this appointment and consent to the evaluation of my character and competence by the Fernley City Council in a public meeting. Further, I acknowledge that I may at any time withdraw both this waiver and related application for appointment.*

I Agree

I Disagree

Acknowledgement

Please Agree with the Following Statement

I certify that, to the best of my knowledge, the information I provided in the application is true. If the information provided is false or incomplete, it shall be sufficient cause for disqualification or removal. If appointed, I agree to attend a board or commission orientation session, if applicable, within six months of my appointment. I understand that failure to comply with this requirement will results in automatic removal from the board or commission.

I Agree

I Disagree