Town of Wareham, MA - Committee Application

Committee Application

I hereby certify:

I am a full-time resident of the Town of Wareham.

I have been provided a summary of MASSACHUSETTS GENERAL LAWS 268A (conflict of interest) and have read

the material provided, and to the best of my understanding have no potential or actual conflict of interest and;

I have been provided with the Board of Selectmen Policy #05-01 and having read the material agree to

the requirement of obtaining ethics training and state-sponsored training (if any) for each term I am

appointed.

Choose from the following:

Checkboxes	Checkbox Description	Checkboxes	Checkbox Description
	I have read & understand the M.G.L. 268A		I have read & understand B.O.S. policy #05-01

Please provide the following information:

Field Description	Field Data	Required Field
Name:		required
Email:		required
Committee/Board/Commission of interest to serve:		required
Alternate Committee (s):
Physical Address:		required
Home Phone:		required
Work Phone:
Registered to Vote?		required
What Town?		required
Hours available per week:		required

Present business and/or work affiliations:

Special training or qualifications:

Town offices held in Wareham or elsewhere:

Field Description	Field Data
You will be required to provide one of the following to the Selectmens Office: driver’s license recent utility bill rent receipt on a landlord’s printed letterhead or lease duplicate copy of voter registration affidavit other government-issued printed identification which contains name and address

Town of Wareham