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Application for City Council Boards and Commissions

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PLEASE READ THE BOARDS AND COMMISSIONS DISCLAIMER

I certify that the information provided in this application are true and correct to the best of my knowledge. I authorize and consent to background checks and to the investigation and verification of all information contained herein. I further authorize all persons having information concerning my qualifications to release information to city representative and release such persons from all liability for any damages connected with the release of such information. I also release and discharge the City of Charlotte from any claims and damages, losses, liabilities, costs, expenses or any other charges or complaints arising out of the City’s use of any information provided pursuant to this release. I understand and agree that any misstatement will be cause for my removal from any board or committee. By submitting this application, I agree to adhere to all city policies pertaining to boards and commissions, including attendance. I understand that affixing my name on this form is deemed an electronic signature that has the effect of a written signature and will be presumed a valid signature, absent notification otherwise. I hereby acknowledge that this application and information provided herein may constitute a public record, and as such may be released in accordance with all applicable public record laws.