Clermont County Boards and Commissions Application

Select One Airport Zoning Board of Appeals Alcohol, Drug Addiction, and Mental Health Board Area 12 Workforce Investment Board Board of Building Appeals Convention and Visitors Bureau, Inc. Board of Trustees Family Services Planning Committee Flood Damage Reduction Regulations Appeals Board Housing Advisory Committee Local Emergency Planning Committee Mental Retardation/Developmental Disabilities Board Planning Commission Public Defender Commission Public Library Board of Trustees Septic System Rehabilitation Financing Committee Transit Advisory Committee Water Management and Sediment Control Appeals Board

Your Name *

Your Email *

Address *

Address (Continued)

City *

State *

Zip Code *

How long have you lived in Clermont County? *

Are you related to, or otherwise closely associated with anyone now employed by Clermont County? *

Primary Phone *

Secondary Phone

High school or equivalent *

Undergraduate school and degree earned

Graduate school and degree earned

Current Occupation *

Employment History (name of employer and occupation) *
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Please list memberships in community organizations, including any offices held *
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Please list participation in civic activities *
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Please state your reasons for applying to the Board / Committee requested *
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Please indicate any special skills, educational background, or experiences that qualify you to serve on the Board / Committee requested *
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Please list three references from the Township / Village / City in which you reside (include name, title, address and phone number) *
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Please list three other references (include name, title, address and phone number) *
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