Personal Information

I am interested in serving on the following committees, boards, commissions or authorities

(select up to three committees)

Date of Application (required. mm/dd/yyyy)

Applicant Name(required)

Email (If you do not have an email address, please type "none".)

Home Phone

Business Phone

Mobile Phone

Residential street address including city and ZIP Code. (required)

(Do not enter a P.O. box.) 

Home Mailing Address

(If different from above.) 

How many years have you lived or worked in Tacoma? 

Applicant Employer name and address

Ethnicity 

The City of Tacoma promotes cultural and ethnic diversity on citizen committees, boards, commissions, and authorities. Information in this section will assist in achieving this goal and is voluntary.

Dates of Service 

Branch of Service 

Date and Type of Discharge 

Please list any community activities that relate to this position. 

(required) 

List any experience that would assist you in serving on this committee, board, commission. 

(required) 

Do you or any of your family members work for or serve on the board of directors of any organization which has contracted with or applied for funding from the City of Tacoma?

Do you anticipate any involvement of this kind in the future?  If yes, please describe the relationship.

(required) 

Are you related to any elected City official or staff member?  If yes, please explain. 

(required) 

Please indicate any activities you are involved with that may present a conflict of interest with the committee, board, commission, or authority you are applying for.  

(required) 

Why are you interested in serving on this committee, board, commission, or authority? 

(required) 

References 1 Name  

References 1 Daytime Phone  

References 2 Name  

References 2 Daytime Phone  

Authorization for reference check   (required)

•  I hereby authorize the City of Tacoma to conduct a reference check by contacting the individuals listed above. Background Checks may be requested, with written authorization.

How did you hear about the vacancy on this committee, board, commission, or authority?

(required) 

•  City Council Member
•  City of Tacoma Press Release
•  City of Tacoma Staff
•  City of Tacoma Website
•  Friend or Co-Worker
•  Neighborhood Council
•  Other

If other was selected, please describe here. 

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