EmailMe Form - Fairfield County Board Member Application

Mail In-Form Option

Printable Form Option

Thank you for your interest in serving. Please return the completed form to:

The Fairfield County Commissioners
Attn: Bennett Niceswanger, Asst. Clerk
210 East Main Street, Room 301
Lancaster, Ohio 43130

or email the completed form to bennett.niceswanger@fairfieldcountyohio.gov.
If you have any questions, please contact Bennett Niceswanger at the email address listed above or at (740) 652-7090.

Online Form Option

Name of Board *

Type *

Your Name *

Address *

(Address, City, State, Zip)

Date of Birth: *

Phone *

E-Mail Address *

How long have you been a resident of Fairfield County: *

Occupation: *

Employer: *

Highest Level of Education Completed: *

Have you ever served on a board before: *

If yes, please indicate the board(s) previously or currently serving on:

Are you related to any Elected Official, Department Head, or County employee: *

If yes, please indicate who:

Have you ever been convicted of a criminal offense: *

(A conviction will not necessarily prohibit you from an appointment. Each conviction will be judged on its own merits with respect to time, circumstance, and seriousness based on the board appointment for which you are applying.)

If yes, please explain:

Please state your reasons for wanting to serve on the board (additional space is provided on the second page). Please highlight specialized interested or experiences that you feel make you qualified to serve. *

Your signature acknowledges that the information which appears on this form and true and factual to the best of your knowledge. *

Clear