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2. Name*
3. Email Address
5. Home Address*
7. Business Address
9. Home Phone
10. Office Phone
12. Cell Phone
13. Volunteer Services To*

    Name of Committee

15. Education
17. High School Name
19. City, State
20. Degree
22. College Name
24. City, State
25. Degree
27. Other Educational Institution
29. City, State
30. Degree
32. Employment History
34. Name of Company

    Most recent employment first

36. City, State
37. Type of Work
39. Name of Company
41. City, State
42. Type of Work
44. Name of Company
46. City, State
47. Type of Work
49. Have you ever served on a committee in Barrington?

    1. Yes
    2. No
50. Have you ever served on a committee in another community?

    1. Yes
    2. No
52. Please list any committees you have formerly served on.
54. Other Volunteer Experience (Including name of organization, position)
56. How long have you resided in Barrington?
58. Previous Address
60. Briefly explain your reason(s) for applying to an appointment to this committee
62. What special talents and experience do you possess which would be useful to the committee?
64. Would you be representing any organization?

    1. Yes
    2. No
65. If yes, which one?

67. The Town of Barrington does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in the employment or provision of services.

    Please be advised that pursuant to Chapter 2 of Title 38 of the Rhode Island General Laws, all the information provided by you to the town in connection with your application for an appointment to a town board/committee is deemed a Public Record subject to disclosure to any person who requests the same.

69. Applicant's Name as Signature*
70. Date*
    Date
Leave This Blank:


72. 1. Receive an email copy of this form.
73. Email address

    This field is not part of the form submission.

74. Submit

* indicates a required field