S:\FORMS\Volunteers\Commission & Committee Application form.rtf
c:\wpwin\admin\comm.app
City of Veneta * 88184 8th Street * PO Box 458 * Veneta OR 97487 * (541) 935-2191 * www.venetaoregon.gov
NAME OF COMMISSION/COMMITTEE: PLEASE CHECK ONE:
____ New applicant
_______________________________________ ____ Application for reappointment
Are you registered to vote in the State of Oregon? □ Yes □ No
Do you live within Veneta City limits? □ Yes □ No
How did you learn about this vacancy?
_____Newspaper _____Word of mouth _____Other
PLEASE PRINT
Name ______________________________________________________________________
(Last) (First)
Address ________________________________________ Home Ph# __________________
Email Address ___________________________________ Cell Ph# ____________________
Occupation __________________________________________________________________
Place of Employment __________________________________________________________
Business Address _____________________________________________________________
Phone _________________ Email _______________________________________________
Signature of Applicant ___________________________________ Date_____________
PLEASE RETURN TO: City of Veneta
P. O. Box 458
88184 8
th
Street
Veneta, OR 97487
It is the policy of the City to comply with all federal and state statutes on equal employment and volunteer
opportunities. This policy shall be applied without regard to any individual employee/volunteer or job
applicant’s sex, race, color, religion, national origin, ancestry, age, marital status, political affiliation, genetic
information, veteran status or any other legally protected status per state and federal law.
Application for Council or
Commission/Committee
click to sign
signature
click to edit