City of Prescott Boards, Commissions, or Committees Application
Name
*
First Name
Last Name
Residence Address
*
City
*
State
Please Select
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Zip
*
Primary Phone Number
*
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Email
*
Please indicate which BCC you are applying to:
First Choice
*
Please Select
Airport Advisory Committee
CDBG Citizens Advisory Committee
Civic Enhancement Committee
Municipal Property Corporation (MPC)
Tourism Advisory Committee
Workforce Housing Committee
* Building Safety Advisory & Appeals Board
* Board of Adjustment
* Fire Board of Appeals
* Industrial Development Authority (IDA)
* Pedestrian, Bicycle & Traffic Advisory Committee
* Planning & Zoning Commission
* Prescott Preservation Commission
* PSPRS - Police
* PSPRS - Fire
* PSPRS - Joint Police and Fire
* BCC's listed with an * have a City of Prescott residency requirement. Use the following link to verify that your home address is within the City of Prescott boundaries: https://gis.yavapaiaz.gov/v4/
Second Choice
Please Select
Airport Advisory Committee
CDBG Citizens Advisory Committee
Civic Enhancement Committee
Municipal Property Corporation (MPC)
Tourism Advisory Committee
Workforce Housing Committee
* Building Safety Advisory & Appeals Board
* Board of Adjustment
* Fire Board of Appeals
* Industrial Development Authority (IDA)
* Pedestrian, Bicycle & Traffic Advisory Committee
* Planning & Zoning Commission
* Prescott Preservation Commission
* PSPRS - Police
* PSPRS - Fire
* PSPRS - Joint Police and Fire
Third Choice
Please Select
Airport Advisory Committee
CDBG Citizens Advisory Committee
Civic Enhancement Committee
Municipal Property Corporation (MPC)
Tourism Advisory Committee
Workforce Housing Committee
* Building Safety Advisory & Appeals Board
* Board of Adjustment
* Fire Board of Appeals
* Industrial Development Authority (IDA)
* Pedestrian, Bicycle & Traffic Advisory Committee
* Planning & Zoning Commission
* Prescott Preservation Commission
* PSPRS - Police
* PSPRS - Fire
* PSPRS - Joint Police and Fire
Please indicate your interest in serving as Chairperson or Vice-Chairperson on the BCC's that you are applying to. Please note: PSPRS, MPC, and IDA do not have Chair or Vice-Chair positions.
*
YES
NO
Briefly explain why you are interested in serving and how you would positively contribute to the BCC's you've selected. 250 Word Maximum.
*
Please select all City of Prescott BCC's you are currently a member of. Use "n/a" if this question is not applicable.
*
N/A
Airport Advisory Committee
Board of Adjustment
Building Safety Advisory & Appeals Board
CDBG Citizens Advisory Committee
Civic Enhancement Committee
Fire Board of Appeals
General Plan Review Committee
Industrial Development Authority (IDA)
Municipal Property Corporation (MPC)
Pedestrian, Bicycle & Traffic Advisory Committee
Planning & Zoning Commission
Prescott Preservation Commission
PSPRS - Fire
PSPRS - Joint Police and Fire
PSPRS - Police
Tourism Advisory Committee
Workforce Housing Committee
Current Employment Information
Employer
*
Phone Number
Employer Email
Are you a resident of the City of Prescott? (Use https://gis.yavapaiaz.gov/v4/ to verify that your home address is within the City of Prescott boundaries.)
*
YES
NO
How long have you resided in the City of Prescott
Referred By:
Professional Experience - Please Include Any Degrees Completed
*
Special Skills or Qualifications acquired from employment, previous volunteer work, etc.
*
Previous Volunteer Experience, include current or past City of Prescott BCC involvement
*
Have you participated in the City of Prescott Citizen's Academy?
*
Yes
No
If "Yes", indicate when you attended
References - Please List Three
# 1 Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Reference Email
*
example@example.com
#2 Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Reference Email
example@example.com
#3 Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Reference Email
example@example.com
Affirmation of Eligibility - Please Attach Additional Information for any "Yes" responses
Are you currently charged with or have you ever been convicted, received deferred adjudication, or entered a guilty plea or nolo contendere for any Felony or Class 1 Misdemeanor offense?
*
YES
NO
To your knowledge, has any formal charge of professional misconduct ever been filed against you by a licensing or regulatory board or by any other disciplinary body in any jurisdiction?
*
YES
NO
In the past five years, have you ever been reprimanded, demoted, disciplined, placed on probation, suspended, cautioned or terminated by an employer as a result of your alleged consumption or use of alcohol, prescription drugs, or illegal drugs?
*
YES
NO
Is there any information that, if it came to light, would embarrass you or reflect negatively on your appointment?
*
YES
NO
Is there any possible conflict of interest, whether financial or personal, or other matter that would create problems or prevent you from fairly and impartially discharging your duties as an appointee?
*
YES
NO
Attach Additional Information here, if applicable
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Please Note: If you are recommended by the Council Subcommittee on Appointments for appointment to a Board, Commission, or Committee, a background investigation is required and will be conducted by the City of Prescott.The City Clerk's Office will follow up with necessary information as required.
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