#5 Committee Member Application Form
City of Janesville
Committee Volunteer Form
Name:E-Mail:
Address:Zip:
Home Phone:Cell Phone:
Employer:Occupation:
Which committee are you interested in serving?
Any committee
Alcohol License AdvisoryLeisure Services Advisory
Cable AdvisoryLibrary Board of Trustees
Citizens Board of ReviewPlan Commission
Citizen Advisory Committee on AppointmentsPolice & Fire Commission (PFC)
Community Development Authority (CDA)Sustainable Janesville
Golf Course AdvisoryTransportation
Historic CommissionZoning Board of Appeals (ZBA)
Oakhill Cemetery Ad Hoc CommitteeIce Skating Advisory
If applying for the Leisure Services Advisory Committee, are you representing
The Ice Skating community?YesNo
If applying for the Oakhill Cemetery Ad Hoc Committee, are you representing:
The Funeral Home Industry?YesNo
A Veterans Group?YesNo
If applying for the Ice Skating Center Advisory Committee, are you representing
Janesville's Youth Hockey Organization?YesNo
Janesville's Figure Skating Club?YesNo
The NAHL/Wisconsin Hockey Partners (WHP)?YesNo
The Janesville School District?YesNo
Are you an alternate applying for a voting member position?YesNo
Are you applying for re-appointment to a committee in which you already serve?YesNo
Doyouhaveanypreviousexperience(includingserviceonanycityorcountycommitteeorvolunteer
Doyouhaveanypreviousexperience(includingserviceonanycityorcountycommitteeorvolunteer
experiences) that would be relevant to the committee of your interest?
Do you have any special qualifications that would be relevant to the committee of your interest?
Do you have any technical training that would be relevant to the committee of your interest?
Why do you wish to serve on a committee?
Please Return to: City of Janesville, City Manager's Office, P.O. Box 5005, Janesville, WI 53547
For questions, call 755-3177.