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2021 Board Application Form

2. Select the Board, Commission, or Committee*
   -- Select One --Construction Board of Appeals Dupre Local Gov't CorporationEconomic Development Corporation Historic Preservation Commission Library Commission Main Street Advisory BoardParks and Recreation CommissionPlanning & Zoning CommissionSustainability CommissionTask Force on Aging CommitteeZoning Board of Adjustments

   For multiple board selections, list your selections in the OTHER SELECTION fields, in priority order.
3. Selection #2
   -- Select One --NO SELECTIONConstruction Board of Appeals Dupre Local Government CorporationEconomic Development CorporationHistoric Preservation CommissionLIbrary CommissionMain Street Advisory BoardParks & Recreation CommissionPlanning & Zoning CommissionSustainability CommissionTask Force on AgingZoning Board of Adjustment

   What is your Selection #2?
4. Selection #3
   -- Select One --NO SELECTIONConstruction Board of AppealsDupre Local Government CorporationEconomic Development CorporationHistoric Preservation CommissionLibrary CommissionMain Street Advisory BoardParks & Recreation CommissionPlanning & Zoning CommissionSustainability CommissionTask Force on AgingZoning Board of Adjustment

   What is your Selection #3?
5. Selection #4 and more
   You may list more than one.
7. Salutation*
8. First Name*
9. Last Name*
11. Address1*
12. Subdivision*
14. City*
    Restrictions may apply. See residency requirement.
15. Email Address*
17. Preferred Phone Number*
18. Mobile Phone Number
20. Occupation/Position*
    If retired, please indicate former occupation.
21. Business Address*
22. Business Phone Number*
24. Residency*

    Are you a resident of the City of Buda city limits?

    1. Yes
    2. No
25. If yes, for how long?
26. If no, in the ETJ?

    If no, are you a resident of the City's Extra-Territorial Jurisdiction (ETJ)?

    1. Yes
    2. No

    1. N/A
28. Registered Voter*

    Are you currently a registered voter in Hays County?

    1. Yes
    2. No. If no, you must be a Registered Voter to qualify.
    3. In the process of obtaining a Voter Registration. Registration must be completed by the deadline date.
29. Disclosure of personal financial interest*

    Disclosure of personal financial interest* Do you have a personal financial interest, direct or indirect, in any matter pending before such officer or employee, or the city council, or a department, agency, commission, or board of which the city official (applicant) is (or may be) a member? If yes, such disclosure will not preclude an individual from serving on a board. If appointed, a form disclosing such interest must be completed and the individual will need to abstain from any discussion or vote on the matter presented before the board or commission. For further information, see Code of Ordinance, Chapter 2, Sec. 2.03.008.

    1. Yes

    1. No
31. Buda Citizen's Academy*

    Have you graduated from or currently participating in the City of Buda Citizen’s Academy?

    1. Yes
    2. No
32. If yes, when?
33. Are you currently or have you ever served on any City Board or Commission?*

    1. Yes
    2. No
34. If yes, please list each board and dates of membership.
36. Qualifications: *
    Describe your qualifications or expertise that relate to your interest in serving on a board/commission. You may attach a resume along with the application.
37. Resume Highly Recommended or Additional Information
39. Do you have any relatives that work for the city of Buda?*

    1. Yes

    1. No
40. If yes, what is their name and position?
42. RESPONSIBILITIES OF BOARD AND COMMISSION MEMBERS
    FORM

    The acknowledgment and review of this Form is a requirement of the application process. Click on the FORM link to view the FORM.
44. ACKNOWLEDGEMENT*

    PLEASE NOTE THIS APPLICATION IS ONLY VALID FOR THE VACANCIES FOR WHICH YOU ARE APPLYING. IF YOU WISH TO APPLY FOR VACANCIES IN THE FUTURE, YOU WILL NEED TO FILE A NEW APPLICATION AT THAT TIME. I hereby certify that the foregoing and any attached statements are true, accurate, and complete. I agree that any misstatement, misrepresentation, or omission of fact may result in my disqualification for appointment. I also understand that this application is subject to disclosure under the Texas Public Information Act.

    1. Check box to acknowledge you are in agreement with the above statement.
46. Responsibilities FORM*

    1. Check box to acknowledge you have read, understand, and agree with the RESPONSIBILITIES OF A BOARD AND COMMISSION MEMBER.
48. 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.
50. Electronic Signature*
51. Date*
    Date

    Date
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit Submit and Print

* indicates a required field