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Boards, Commissions & Committees Application

  1. This Information Will Become Public Record

  2. Personal Reference 1

  3. Personal Reference 2

  4. Registered Voter*

  5. Have you ever been a member of a Rosenberg committee, board, commission, or task force before?*

  6. Have you ever been convicted of a felony or a misdemeanor involving moral turpitude?*

  7. Felony / Crime Agreement

    The applicant affirms on his/her application that they have not been convicted of a felony or crime involving moral turpitude; not be an adversary party to pending litigation against the City, except for eminent domain proceedings; claims against the City not in litigation do not serve as a disqualification under this subsection but will be brought to the attention of the City Council; disqualification of an applicant or an appointee under this subsection may be waived by the City Council after review of the specific circumstances. The applicant hereby authorizes the City to perform a criminal background check as a condition of appointment to a City board or commission.

  8. There are a number of boards which may require special qualifications such as plumbers, electricians, etc.

  9. Are you related, by marriage or blood, to any member of the City Council or the City Manager?*

  10. If you are related within the second degree by marriage or third degree by blood, you may be prohibited from serving on a committee. Prohibited degrees of relationship are defined as follows: (Blood) First Degree: Father, Mother, Son, Daughter Second Degree: Brother, Sister, Grandfather, Grandmother, Granddaughter, Grandson Third Degree: Aunt, Uncle, Nephew, Niece, Great Grandfather, Great Grandmother, Great Granddaughter, Great Grandson (and the spouses of the above persons are also included in the prohibited degree of relationship). (Marriage) First Degree: Father, Mother, Son, Daughter Second Degree: Brother, Sister, Grandfather, Grandmother, Granddaughter, Grandson

  11. Are you currently in arrears on any City taxes, water service charges, or other obligations owed the City?*

  12. Affirmation of Information Provided*

  13. Leave This Blank:

  14. This field is not part of the form submission.