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2. Date:*
3. Ald. Dist./Ward:
5. First Name*
6. Last Name*
8. Address1*
10. Address2
12. City*
13. State*
14. Zip*
16. Home Phone:*
17. Work Phone:
19. Employer:
20. Occupation:
22. Email:*
23. Cell Phone:
25. Boards/Commissions/Committees of interest:

    1. Board of Police Commissioners
    2. Central Square Committee
    3. Heritage & Architecture Commission
    4. Lincoln Landing Site Council

    1. Planning & Zoning Commission
    2. Police Pension Board
    3. International Code Council Board of Appeals
26. Current Committee Service:
28. Qualifications for appointment:
29. Education, Experience, and Background:
31. Public Service and/or City Involvement:
33. Do you live in Lockport?:

    1. Yes
    2. No
34. Do you hold an elected or appointed public position or office?:

    1. Yes
    2. No
36. If "yes," what position or office?:
37. Resume:
39. Signature of Applicant (Entering your name electronically represents you signing this e-form):*
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field