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Boards & Commissions Application Form

  1. Please complete the online form below.

  2. Personal Information

  3. *Some Boards or Commissions do not require city residency, but may require business involvement within the City of Danville. If this is applicable, please be sure to fill out the following business questions.

  4. Are you a registered voter:*

  5. Education

  6. Civic Activities

  7. Are you currently serving on other City of Danville Boards, Commissions, or Committees?*

  8. Have you served on a Board, Commission, or Committee before?*

  9. Do you have a valid Virginia driver's license?*

  10. Are your accounts current with the City (Taxes, Utilities, etc.?) *

  11. References

  12. Persons who are not relatives. List name, address and phone number(s).


  13. Criminal Record and Child Protective Services Information

  14. (Provide information regarding the nature of the convictions and approximate date(s) of "Yes" answers.

  15. I hereby certify that the information provided on this application is correct to the best of my knowledge and belief. I also hereby authorize the officials of the Central Criminal Records Exchange, and law enforcement officials or officers, the Commissioner of the Department of Motor Vehicles, or any officer or employee of the Department of Motor Vehicles, the Commissioner of the Revenue of the City of Danville, Virginia, The Treasurer of the City of Danville, Virginia, the Director of Central Collections for the City of Danville, Virginia and/or any other person or official to provide any information relating to my record with respect to convictions for traffic violations or other offenses involving the operation of a motor vehicle, felony, or misdemeanor convictions, if any, and/or taxes assessed against me or my property which are delinquent, if any, to the City Clerk, the Council of the City of Danville, Virginia, and/or to any other person designated by the Council to receive such information.

  16. I AM WILLING TO SERVE ON MORE THAN ONE (1) AUTHORITY, BOARD, OR COMMMISSION CONCURRENTLY.

  17. NOTE: Successful candidates for the Board of Zoning Appeals, Planning Commission, Utility Commission, IDA, and the Housing Authority are required by State Law to complete a Conflict of Interest Form as a condition of taking office and thereafter annually on January 15.

  18. Danville City Code Section 2-45(a) "Any person appointed by Council to a board or commission who fails to attend seventy-five(75) percent of the regular meetings of said board or commission will be deemed to have resigned from that office."

  19. CONTACT THE CITY CLERK'S OFFICE FOR FURTHER INFORMATION:

    TELEPHONE: (434) 797-8928
    FACSIMILE: (434) 799-5041
    E MAIL: sdemasi@ci.danville.va.us

  20. BY CLICKING "SUBMIT" YOU ARE SENDING AN ELECTRONIC SIGNATURE THAT VERIFIES EVERYTHING IN THIS APPLICATION IS TRUE AND ACCURATE. IF YOU DO NOT WISH TO SUBMIT AN ELECTORNIC SIGNATURE, PLEASE USE THE CANCEL BUTTON TO EXIT THE APPLICATION.

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