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Application for Appointment

  1. Type of Appointment
  2. Are you willing to serve on more than one Authority, Board, Commission, or Committee?
  3. Gender
    For diversity purposes only.
  4. For diversity purposes only.
  5. Are you a resident of the City of Roanoke?
  6. Are you a registered voter?
  7. Are your accounts current with the City (Taxes, Utilities, etc.)?
  8. Are you over the age of 18?
  9. (For purposes of this question, “entity” specifically includes, but is not limited to, the City of Roanoke and any entity which receives funds from the City.)
  10. Have you ever been convicted of a law violation, including moving traffic violations, since your 18th birthday?
  11. Have you ever been convicted of a felony?
  12. Have you ever been convicted of a misdemeanor involving moral turpitude (any offense involving lying, stealing, or cheating) since your 18th birthday?
  13. Are there any criminal charges or proceedings pending against you?
  14. By submitting this form, you hereby certify that the criminal information is true, accurate and complete.
  15. Leave This Blank:

  16. This field is not part of the form submission.