Notice of Interest

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Please correct the field(s) marked in red below:

The Town of Queen Creek depends on its citizens to help advance the community toward its goals. Residents can participate in local decision-making by serving on volunteer boards, commissions,  committees and task forces. In most cases, volunteer members act in an advisory capacity making  recommendations to the Town Council.

Appointments are made by approval of the Town Council. If you would like to be considered for an appointment, complete this form, attach a resume or letter about yourself and return all documents to:

Town of Queen Creek
Town Clerk’s Office
22350 S. Ellsworth Road
Queen Creek, AZ 85142
Fax: 480-358-3001

[PDF version of this form]

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Date
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Name
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Name
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Home Address
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4
Mailing Address (if different than home address)
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Occupation
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Phone
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Phone
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Email Address
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How long have you been a resident of Queen Creek?
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Are you a registered voter?
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Are you a registered voter?
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Do you live within the Town's incorporated limits?
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Do you live within the Town's incorporated limits?
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Have you participated in the Queen Creek Citizen Leadership Institute?
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Have you participated in the Queen Creek Citizen Leadership Institute?
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If yes, did you graduate?
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If yes, did you graduate?
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Which boards, commissions, committees or task forces have you served on in the past, in Queen Creek or elsewhere? 
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I am interested in serving on: (Please rank the committees you are interested in, with 1 being your first choice.)
I am interested in serving on: (Please rank the committees you are interested in, with 1 being your first choice.)
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Please describe why you would like to serve on this board, committee, commission, etc.
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Please describe special knowledge or expertise you have that would benefit the Town.
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Please list community, civic, professional, social, cultural or athletic organizations you have been affiliated with and in what capacity.
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Are you available for evening meetings?
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Are you available for evening meetings?
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Are you available for morning meetings?
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Are you available for morning meetings?
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Are you available for lunch meetings?
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Are you available for lunch meetings?
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Are there days of the week you are not available for meetings? (Check all that apply)
Are there days of the week you are not available for meetings? (Check all that apply)
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Resume

I hereby acknowledge that all information provided on this application is subject to disclosure pursuant to the Arizona Public Records Law. I understand that members of boards, commissions, committees and task forces are subject to disclosure of conflicts of interest. I certify that the information contained herein is true and accurate to the best of my knowledge.

Note: Notice of Interest forms will be kept on file for 12 months. After that, they will expire and applicant’s will need to submit a new form.

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Signature
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