Volunteer Fact Sheet

PDF Version of Volunteer Fact Sheet Form

City of Franklin / 9229 W. Loomis Road / Franklin, WI 53132
414-425-7500 / 414-425-6428 (Fax)

Thank you for your interest in serving on a City Board, Commission, or Committee. In order that consistent information be provided to the Common Council, you are asked to complete the following:

Personal Information:

Name

Address

Phone Number

Email Address

Years as a Franklin resident

Alderman or District No. (if known)

Area of Interest:

Please check the box next to the Board, Commission, or Committee of greatest interest. If checking more than one, please prioritize your top three choices in the space given below, listing the first as top priority and so on.

Architectural Review Board		Civic Celebrations Commission
Community Development Authority		Economic Development Commission
Environmental Commission		Finance Committee
Fair Commission		Board of Health
Fire and Police Commission		Parks Commission
Library Board		Plan Commission
Personnel Committee		Board of Review
Board of Public Works		Quarry Monitoring Committee
Technology Commission		Tourism Commission
Board of Zoning & Building Appeals		Waste Facilities Monitoring Committee
Board of Water Commissioners

If more than 1 box is checked above, please prioritize your choices listing the first as top priority and so on:

Why are you interested in joining this (these) particular Board and/or Committee/Commission?

Volunteer or Work Experience:

Begin with your most recent employment and continue with all past 10 years of employment.

Job 1

Company Name
Address
Telephone
Start Date / Position
End Date / Position Upon Leaving
Description of Duties

Job 2

Company Name
Address
Telephone
Start Date / Position
End Date / Position Upon Leaving
Description of Duties

Job 3

Company Name
Address
Telephone
Start Date / Position
End Date / Position Upon Leaving
Description of Duties

Additional Experience of Qualifications:

List any other experience, skills, or other qualifications (including hobbies) which you believe should be considered in evaluating your qualifications for volunteering.

I am aware that all of the information provided and this document itself is a public record which will be released to a requestor; that I authorize such release and that I waive any right to any notice of such release and/or any right of notice to augment the information provided upon this document upon such request or release.

Signature Date

NOTIFICATION & AGREEMENT

I certify that the information provided by me in this Application is true and complete to the best of my knowledge. I understand that if I am appointed, any false statements or omissions can be cause for reconsideration or termination of the appointment.

The City of Franklin is hereby authorized to verify the information I have supplied and to conduct any review or investigation of my personal history. By signing below I also authorize the City of Franklin and it's assigns to perform a background check on all information provided by me on this application, including but not limited to, information related to past or pending criminal charges, past criminal convictions, education and employment history, and the status of property tax, fines, and fee payments I owe the City. I further authorize any holder of information pertaining to the information supplied by me on this application to release such information to the City, which shall remain confidential to the extent provided for pursuant to Wisconsin law. I understand and agree that the City shall not be held liable in my respect for any actions taken by the City to check such information. I further understand and agree that the record of the information obtained during the background check is a public record and is subject to release upon a request for the record, subject to the considerations to be made under and the application of the Wisconsin open records laws.

It is the intent of the City of Franklin to comply with all state and federal requirements and to operate within the law in the implementation of all facets of equal opportunity and affirmative action. In the recruitment, selection, utilization, or termination of Board and Commission appointments, there will be no discrimation on the basis of race, color, religious belief, age, gender, sexual orientation, national origin, citizenship status, disability, marital status, pregnancy. Do not include information of this nature in the application. It is the City of Franklin's intention that all qualified applicants be given equal opportunity and that selection decisions be based on position-related factors.

I understand that should a Board or Commission appointment offer be extended to me and accepted I will be subject to and will fully adhere to the policies, rules, and regulations of the City of Franklin and State of Wisconsin, including but not limited to those related to ethical standards, public records, and public meetings.

Signature Date

Applications are kept on file for 2 years.