Boards & Commissions Interest Form

(* Denotes Required Fields)

Your Information
First Name: *
Last Name: *
Address: *
Is your address located in Meriden?: *
Please note that non-city residents may not serve on committees.  
City: *
State: *
Zip Code: *
Telephone Number:
Email Address: *
Voter Party Affiliation: *
If you selected "other" please advise your party affiliation:
In what year did you move to Meriden?:
Current Employer Name: *
Highest Level of Education Received:
Do you own any interest in a business located in Meriden, CT?: *
Business Name: *
Have you served or are currently serving on any board or commission in Meriden or any other community?: *
If so, please list the names and locations of these boards and committees:
Boards and Committees
Please check any or all of the boards or commissions you are interested in serving: *
If you selected "other" please name the board or commission in which you wish to serve:
Why do you wish to serve on a particular board or commission? : *
How do you wish to contribute to the work of the board or commission (be specific):
Electronic Signature
Please type your name and date to signify that you can serve on a board or commission and the information in this application is accurate to the best of your knowledge. * 
Full Name: *
Date: *
*As part of the vetting process the Mayor’s office will confirm that you are a registered voter in Meriden and that your party affiliation is correct.  The office will also confirm that your personal property, motor vehicle and water/sewer taxes are current, and will do the same for any business in which you have an ownership interest that is located in Meriden.

** All persons being considered for the Civilian Police Review Board shall be subject to a criminal background check. The background check results shall be kept confidential. No person shall be appointed to the Civilian Police Review Board who has a Class A or B felony conviction, a Class C or D felony conviction in the last 5 years, or a pending criminal case.