2. This application and all information contained herein is a public record. Public service opportunities are offered by the Town of Bartonville without regard to race, color, national origin, religion, sex, genetic information or disability
4. Date & Time
   Date & Time

   Date & Time
6. First Name*
7. Last Name*
9. Address1*
11. City*
12. State*
13. Zip*
15. Phone Number*
17. Email Address
19. Length of Residency in Bartonville*
21. Occupation (if retired, indicate former occupation/profession)*
23. List any experience that qualifies you to serve in the position(s) sought:
25. Are you currently serving on a Board, Commissions, or other capacity?*

    1. Yes
    2. No
27. If yes, which
29. Have you served on a Board, Commission, or Committee before?*

    1. Yes
    2. No
31. If yes, which
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

* indicates a required field