TOWNSHIP OF WASHINGTON
                     COUNTY OF WARREN, STATE OF NEW JERSEY
                             CITIZEN INVOLVEMENT APPLICATION 

All Citizens of the Township of Washington interested in having their names considered for appointment by the Township Committee at such time as a vacancy occurs in any committee where appointments are made by the Committee, or on any special committee created by the Committee shall print and fill out this application and return it to the Township Clerk, 350 Route 57 West, Washington, NJ 07882, or fax to (908) 689-9234 or e-mail the information below to twpclerk@washington-twp-warren.org  

Name ______________________________________________________

Address: ____________________________________________________

Telephone: Home                                               Business:                                      

How long have you resided in Washington Township? Years:                              

Educational level obtained (circle one) 8 9 10 11 12 13 14 15 16 17 18+ 

Educational Specialty or Field                                                                                  

Employment Experience:
Company                                         Position Held                            Years of Service 

                                                 __                                   _________                        

                                                 __                                  _________                        

                                               ___                                  _________                        

Civic Involvement: 
Organization                                   Position Held                             Years of Service  

                                                 __                                  _________                        

                                                 __                                  _________                        

                                                 __                                 _________                         

Areas of Particular Interest in Local Government: (Check one or more) 

(  ) Land Use Board
(  ) Public Assistance
(  ) Environmental Commission 
(  ) Historic Preservation Commission 
(  ) Recreation Commission
(  ) Open Space Advisory Committee 
(  ) Affordable Housing
(  ) Municipal Alliance
(  ) Economic Development Committee
(  ) Citizens Adivisory  Committee