Application for Appointment to a Public Board, Commission, or Committee

Fill this in on screen, then print it to sign. Nothing you type is sent anywhere — the form works entirely in your browser. If you would rather write it out by hand, print the blank page first.

Persons interested in being appointed to serve on a board, commission, or committee of Pickaway County are invited to complete the following application.

Name

Street Address

City

State

Zip Code

Residence Telephone Number

Work Telephone Number

Email Address

Name of Board, Commission, or Committee on which you would like to serve

Brief Description of Background and Qualifications

Additional information may be attached on separate sheets

Signature of Applicant (sign after printing)

Date

Sign the printed copy, then deliver or mail it to the Pickaway County Commissioners, 139 West Franklin Street, Circleville, Ohio 43113.