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2. PERSONAL INFORMATION
4. Prefix*
   -- Select One --Mr.Mrs.Ms.
5. First Name*
6. Last Name*
8. Address*
10. City*
11. State*
12. Zip*
14. Home Phone Number*
15. Email Address
17. Employer*
18. Title/Occupation*
20. Employer Address*
21. State*
22. Zip Code*
26. ADDITIONAL INFORMATION
28. How long have you lived continuously in the City of Romulus*
29. Are you a registered voter*

    1. Yes

    1. No
31. Are you affiliated with any political party?*

    1. Yes

    1. No
32. Are you a graduate of Romulus Citizen Academy?*

    1. Yes

    1. No
34. Are you related to any employed by, or an elected official of the CIty of Romulus?*

    1. Yes

    1. No
35. If yes, please provide the person's name and your relationship
37. Have you ever been convicted for anything other than a minor traffic violation?*

    1. Yes

    1. No
38. Do you have access to electronic resources?*

    1. Yes

    1. No

           i.e. home computer, email, internet access

42. BOARDS & COMMISSIONS
44. Select UP TO three (3) boards or committees you wish to apply for in the order of your preference*

    1. Arts Council & Commission
    2. Beautification Committee
    3. Board of Zoning Appeal
    4. Board of Review
    5. Brownfield Development Authority Board
    6. Cemetery Board of Trustees
    7. Charter Committee
    8. Downtown Development Authority (DDA)
    9. Construction Board of Appeals
    10. Electronic Sign Commission

    1. Environmental Protection Board
    2. Historical Commission
    3. Housing Commission
    4. Municipal Library Board
    5. Officer Compensation Commission
    6. Planning Commission
    7. Police, Fire & Safety Commission
    8. Property Disposition Committee
    9. Recreation Commission
    10. Tax Increment Finance Authority Committee (TIFA)
46. Selections*

    List your first, second, and third choice

50. EDUCATIONAL & WORK BACKGROUND
52. High School*
53. Year of Completion*
54. Degree Obtained*
56. College or University
57. Year of Graduation
58. Degree Obtained
60. Trade or Business School
61. Year of Completion
62. Certificate Obtained
64. Other Certifications or Degrees

    Please include the year of completion

66. Professional Qualifications and/or Work Experience Relevant to the Board or Commission*
70. COMMUNITY ENGAGEMENT
72. Community Activities and/or Other Experience
74. Three Personal or Business References*

    List name and contact information

76. Why are you interested in this particular board or commission?*
78. Any other additional information you would like to share
80. SUPPLEMENTAL INFORMATION

    Please review the "Boards and Commissions Application Attachment" for the desired qualifications for each board and commission. Check the appropriate box or boxes to indicate whether you have experience or professional credentials that may be needed to fill a specific seat. Resumes are encouraged and may be attached to your completed application. 

    Some boards and commissions are a mix of citizens with certain qualifications and others are citizens representing the general public. Even if you do not have any of the experience or professional background listed below, we urge you to apply for consideration. Romulus needs citizens with diverse backgrounds on its boards and commissions.

82. Upload here

    Upload your resume and/or the Board & Commission Application Attachment

83. Board & Commission Application Attachment

    Application Attachment

85. EXPECTATIONS

    If appointed, members are expected to make every effort to be active members of the board, committee, or commission. This includes:

    1. Attending meetings on a regular basis
    2. Reviewing meeting materials prior to the meeting.
    3. Adhering to the city's ethics policy
    4. Representing the interests of the Romulus community as a whole
    5. Learning and utilizing key tools such as plans, policies, and input from public engagement.
87. IMPORTANT PUBLIC RECORDS INFORMATION

    All information submitted in this application is public information and subject to disclosure in response to a public records request made pursuant to the Freedom of Information Act. Please contact the City Clerk's office at 734-942-7540 if you have any questions or concerns about the disclosure of specific information.

89. TRUTH AND ACCURACY*

    I certify that the information contained on this form is accurate and complete to the best of my knowledge. I understand that all information disclosed on this form will be available to the public as part of a Freedom of Information Act request.

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
91. Electronic Signature*
92. Date Signed*
    Date Signed
Leave This Blank:


94. 1. Receive an email copy of this form.
95. Email address

    This field is not part of the form submission.

96. Submit Submit and Print

* indicates a required field