Form Center • Hot Springs, AR • CivicEngage

Step One

Boards & Commissions Application
To be eligible for nomination for a board, commission or committee, you must be a registered voter residing within the city limits and, in some cases, reside within a specific board district of Hot Springs.
Full Legal Name
Advisory Board, Commission, or Committee
Board(s), Commission(s), or Committee(s) applying for:
Please rank the Boards, Commissions or Committees (BCC) in which you would serve and rank in order of preference.
The highest rank is #1 and the lowest is #3. You may also choose - Not Interested - if there's no other BCC you wish to serve on or - Willing to Serve on Any Open Position - if you are just interested in serving.
Highest Rank (#1)*
Choose one.
Second Choice (#2)*
Choose one.
Third Choice (#3)*
Choose one.
General Information
City Board District Residency
Voter Registration Number
City Board District Residency*
1. District 1
2. District 2
3. District 3
4. District 4
1. District 5
2. District 6
3. Outside of City
Home Address
City
State
Zip Code
I have lived in Hot Springs for more than 3 years
1. Yes
2. No
I am a customer of Hot Springs Utilities
1. Yes
2. No
Home Phone
Cell Phone
Email
Business Name
Business Address
City
State
Zip Code
Business Phone
Applicants are required to attend one regular meeting of the Advisory Group for which they are applying. Please list the name, date and location of the advisory group meeting you have attended.
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Reason for Applying
Please describe your reason for applying for this specific advisory group, detailing any unique talents, experiences, or interests that would help make you an excellent member for this group. Also, include any particular goals you would like to see the advisory group achieve in the future.
Skills & Qualifications
List any specific skills/abilities and/or qualifications that are relevant to the Advisory Group for which you are applying.
Education
Please describe your educational background including all degrees, technical training, certificates, etc. that support your application to this Advisory Group.
Community Service and Activities
Please describe your community service activities.
Additional Comments
Please use this space for any additional information you would like to share about yourself regarding your interest in serving on this advisory group.
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Elected Positions
List any elective office of the city, county or state that you currently hold.
Family Relationships
Do you have any family members who are currently or were within the past two years employed by the City of Hot Springs? If so, please list names, relationship with you, and the department in which they were employed.
Business Relationships
Do you conduct any business with the City of Hot Springs? If so, please explain the nature of that business.
Criminal History*
Have you ever been convicted of a felony?
1. Yes
2. No
Please explain*
If so, please provide the nature of the charge.
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References
Please provide names and telephone numbers of three references other than relatives.
1. Name
Phone Number
2. Name
Phone Number
3. Name
Phone Number
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Acknowledgement *
I certify that the above information is true and accurate to best of my knowledge; and further, that I understand that I am required to attend a meeting of the committee for which I am applying and the interview meeting with the Board of Directors. I understand that the information provided herein is subject to the Freedom of Information Act.
1. Yes

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