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2. 
3. TOWNSHIP OF BLOOMFIELD, NJ

   1 Municipal Plaza, Bloomfield, New Jersey 07003

   
   

   GET INVOLVED! JOIN A BOARD OR COMMITTEE!

5. Application for Appointment for Board or Committee
7. First Name:*
8. Last Name:*
10. Home Address:*
12. Phone Number:*
13. Business Phone:
14. Email Address:*
16. Current Profession or Job Title:
18. List in order of preference, Committee/s to which you would like to be appointed:
20. List the committee/s to which you would like to be appointed:

    1. Animal Shelter Advisory Committee
    2. Beautification Committee
    3. Bloomfield Hispanic Heritage Committee
    4. Board of Health
    5. CATV Program Committee
    6. Civil & Human Rights Commission
    7. Environmental Commission
    8. Flood Mitigation Advisory Committee
    9. Historic Preservation Commission
    10. Juneteenth Holiday Advisory Committee
    11. Mayor’s Senior Citizen Advisory Committee

    1. MLK Day of Service Advisory Committee
    2. Morris Canal Greenway Committee
    3. Open Space Trust Fund
    4. Parks, Recreation & Cultural Affairs Committee
    5. Planning Board
    6. Public Library Board of Trustees
    7. Recycling Committee
    8. Rent Leveling Board
    9. Women’s History Month Advisory Committee
    10. Youth Guidance Council
    11. Zoning Board
22. State some reasons justifying your appointment to the above Committee/s
24. Please describe briefly relevant background, and/or training:
26. Have you served previously on a Committee in Bloomfield Township?*
    -- Select One --YesNo
28. If Yes, Above, please select all that apply.

    1. Animal Shelter Advisory Committee
    2. Beautification Committee
    3. Bloomfield Hispanic Heritage Committee
    4. Board of Health
    5. CATV Program Committee
    6. Civil & Human Rights Commission
    7. Environmental Commission
    8. Flood Mitigation Advisory Committee
    9. Historic Preservation Commission
    10. Juneteenth Holiday Advisory Committee
    11. Mayor’s Senior Citizen Advisory Committee

    1. MLK Day of Service Advisory Committee
    2. Morris Canal Greenway Committee
    3. Open Space Trust Fund
    4. Parks, Recreation & Cultural Affairs Committee
    5. Planning Board
    6. Public Library Board of Trustees
    7. Recycling Committee
    8. Rent Leveling Board
    9. Women’s History Month Advisory Committee
    10. Youth Guidance Council
    11. Zoning Board
30. If yes, please supply details and dates of the committee that you served on:
32. Please upload your resume or CV:*
33. Tell us about you. Please upload a letter of interest:*
35. Please upload any other relevant document(s):
36. Please upload any other relevant document(s):
38. 
39. To Learn more about our Boards and Committee:

    https://onboard.bloomfieldtwpnj.com/

41. 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.
43. Please Select the Date and Time of Submittal:*
    Please Select the Date and Time of Submittal:

    Please Select the Date and Time of Submittal:
44. Electronic Signature*
46. NOTE:
    1. Attendance at all board, or committee meetings may have a minimum attendance requirement. You will be notified upon appointment to a board, or committee of the meeting attendance requirements. If not selected, your application will remain on file in the Township Clerk's Office for one year for consideration of future vacancies.
48. NOTE:

    Questions related to the application process can be directed to the Clerk’s Office: 973-680-4015. 

50. Application is subject to change without notice.
Leave This Blank:


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

    This field is not part of the form submission.

54. Submit

* indicates a required field