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2. Application for Appointment

   Volunteer Boards, Committees, Councils, and Commissions

   Apply for the Police Accountability Board (PAB) and/or Administrative Charging Committee (ACC) (separate application)

   If you have any questions please contact Ashley Staples-Reid at 410-535-1600 ext. 2214 or Ashley.Staples-Reid@calvertcountymd.gov.

4. Board or Commission Name*
   -- Select One --Adult Guardianship Review Board (AGRB)Agricultural Preservation Advisory Board (APAB)Animal Matters Hearing Board (AMHB)Animal Shelter Advisory Board (ASAB)Architectural Review Committee, Dunkirk Town Center (DARC)Architectural Review Committee, Huntingtown Town Center (HARC)Architectural Review Committee, Lusby Town Center (LARC)Architectural Review Committee, Owings Town Center (OARC)Architectural Review Committee, Prince Frederick Town Center (PFARC)Architectural Review Committee, Solomons Town Center (SARC)Architectural Review Committee, St. Leonard Town Center (SLARC)Board of Appeals (BOA)Board of Library Trustees (BOLT)Building Board of Calvert County (BBCC)Calvert County Commission for Women (CCCW)Calvert County Ethics Commission (CCEC)Calvert County Family Network Board of Directors (CCFN)Calvert Marine Museum Board of Governors (CMMBOG)Commission on Aging (COA)Cove Point Light Station Commission (CPLSC)Economic Development Advisory Commission (EDAC)Economic Development Authority (EDA)Emergency Medical Services Advisory Committee (EMS)Employees' Retirement Plan Board of Trustees (ERPBOT)Employees' Retirement Savings Plan Board of Trustees (ERSPBOT)Environmental Commission (EC)Fire and Rescue Commission (FRC)Gambling Permit Review Committee (GPRC)Heritage Committee (HC)Historic District Commission (HDC)Housing Authority of Calvert County (HACC)Local Behavioral Health Advisory Council (LBHAC)Other Post Employment Benefits Trust Fund Board of Trustees (OPEB)Parks and Recreation Advisory Board (PRAB)Planning Commission (PC)Sheriff's Dept. Pension Plan Board of Trustees (SDPPBOT)Social Services Advisory Board (SSAB)Veterans Affairs Commission (VAC)Waterman's Wharf Oversight Committee

   The Police Accountability Board (PAB) and Administrative Charging Committee (ACC) use a separate application form. Apply for the PAB and/or ACC 

6. Last Name*
7. Middle Initial
8. First Name*
10. Nickname
12. Mailing Address*
14. Address Line 2
16. City*
17. State:*
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
18. Zip Code:*
20. Is Your Home Address Different?*

    1. Yes

    1. No
22. Home Address
24. Address Line 2
26. City:
27. State:
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
28. Zip Code:
30. Home Phone Number
31. Cell Phone Number
33. Work Phone Number
34. Extension (if applicable)
36. Email Address*
38. Registered Voter District*

    1. District 1

    1. District 2

    1. District 3

40. The appointment of members shall take into consideration a balanced representation of all segments of the Calvert County community. It is the County Commissioner's intent to appoint Calvert County residents to boards, committees, councils and commissions unless there are no County residents available to fill positions or where an exception is approved for good cause shown in the instance of a specific board, committee, council or commission.

42. Interest and/or experience that would be of benefit to this Board, Commission, or Committee*
44. What is your interest in serving on the Board, Commission, or Committee*
46. Brief education/work history *
    Resume is required (max three pages)
48. Resume Upload
50. How did you hear about this vacancy?*

    1. Channel 6
    2. Newspaper

    1. Website
    2. Referral

    1. Other
52. Other Details
    You selected other, so please describe where you heard about the vacancy.
54. Are you currently serving on other Boards, Commissions, or Committees?*

    1. Yes

    1. No
56. If appointed, I will be able to attend regularly scheduled meetings.*

    1. Yes

    1. No
58. Please Explain*
    You answered 'No' to the above question about attending regular meetings. Please explain why you will not be able to attend.
60. If appointed, I authorize the release of my contact information to the press of public (if requested).*

    1. Yes

    1. No
62. I understand; appointees to Calvert County boards and commissions are required to comply with Code of Ethics § 41.15.B.2: regarding financial disclosure for any potential conflict of interest upon appointment, completion of term, annually, and/or termination.*

    1. I understand
64. By typing your name below, you are certifying the above information is correct and complete.*

    1. Check here to confirm
66. First and Last Name of Applicant
67. Date
    Date
Leave This Blank:


69. 1. Receive an email copy of this form.
70. Email address

    This field is not part of the form submission.

71. Submit

* indicates a required field