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4. 
5. TOWNSHIP OF BLOOMFIELD, NJ 07003
7. Application for Appointment for Board or Commission
9. First Name:*
10. Last Name:*
12. Home Address:*
14. Phone Number:*
15. Business Phone:
17. Current Profession or Job Title:
19. List in order of preference, Committee/s to which you would like to be appointed:
21. List the committee/s to which you would like to be appointed:

    1. Animal Shelter Advisory Committee
    2. Bloomfield Commission on Civil Rights
    3. Bloomfield Parks, Recreation & Cultural Affairs
    4. Bloomfield Municipal Alliance Committee-BMAC
    5. Board of Health
    6. Environmental Commission
    7. Historic Preservation Commission
    8. Morris Canal Greenway Committee
    9. Municipal Youth Guidance Council
    10. Open Space Trust Committee
    11. Planning Board

    1. Recycling Committee
    2. Rent Leveling Board
    3. Zoning Board
    4. CATV Program Committee
    5. Business Advisory Board
    6. Beautification Committee
    7. Bloomfield Cultural Preservation Advisory Committee
    8. Civil & Human Rights Commission
    9. Garden Committee
    10. Juneteenth Holiday Advisory Committee
    11. Local Emergency Planning Council
23. State some reasons justifying your appointment to the above Committee/s
25. Please describe briefly relevant background, and/or training:
27. Have you served previously on a Committee in Bloomfield Township?*
    -- Select One --YesNo
29. If Yes, Above, please select all that apply.

    1. Animal Shelter Advisory Committee
    2. Bloomfield Commission on Civil Rights
    3. Bloomfield Parks, Recreation & Cultural Affairs
    4. Bloomfield Municipal Alliance Committee-BMAC
    5. Board of Health
    6. Environmental Commission
    7. Historic Preservation Commission
    8. Morris Canal Greenway Committee
    9. Municipal Youth Guidance Council
    10. Open Space Trust Committee
    11. Planning Board

    1. Recycling Committee
    2. Rent Leveling Board
    3. Zoning Board
    4. CATV Program Committee
    5. Business Advisory Board
    6. Beautification Committee
    7. Bloomfield Cultural Preservation Advisory Committee
    8. Civil & Human Rights Commission
    9. Garden Committee
    10. Juneteenth Holiday Advisory Committee
    11. Local Emergency Planning Council
31. If yes, please supply details and dates of the committee that you served on:
33. To Learn more about our Boards and Commissions:

    https://onboard.bloomfieldtwpnj.com/

35. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
37. Please Select the Data and Time of Submital:*
    Please Select the Data and Time of Submital:

    Please Select the Data and Time of Submital:
38. Electronic Signature*
40. NOTE:

    Your Form is Submitted to the Township Clerk, Louise M. Palagano Bloomfield Township Municipal Clerk 1 Municipal Plaza ~ Room 214 Bloomfield, NJ 07003 She can Be reached via Phone 973-680-4015

Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field