2. ST. BERNARD PARISH GOVERNMENT - BOARDS AND COMMISSIONS APPLICATIONS
   We consider applications for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job related medical condition or handicap, or any other legally protected status.
   
   (Please Note: All information must be supplied in order for application to be considered by Appointments Review Board)
   
   If you would like to submit a physical application you can download the form here (PDF).
6. Date
   Date
8. Last Name*
9. First Name*
10. MI
12. Address
14. City
15. State
16. Zip Code
18. Phone
19. Referrer
21. Name and relationship of any relatives on Boards/Commission or in our employ
25. Appointment Requested
27. Board or Commission Requested*
29. Are you currently serving on any board/commission?*

    1. Yes
    2. No
31. Are you currently employed by St. Bernard Parish Government?*

    1. Yes
    2. No
32. If yes, What position?
34. Are you an elected or appointed official?*

    1. Yes
    2. No
35. Are you a registered voter in St. Bernard Parish?*

    1. Yes
    2. No
37. Have you been convicted of a felony within the last seven (7) years?*

    1. Yes
    2. No
41. Education
43. High School
44. Number Of Years
45. Year Graduated
46. Subjects Studied
48. College
49. Number of Years
50. Year Graduated
51. Subjects Studied
53. Trade/Business School
54. Number of Years
55. Year Graduated
56. Subjects Studied
60. Employment
    List the last two employers, starting with the last/present one first.
62. Date Employed
    Date Employed Start Date

    —

    Date Employed End Date
63. Name and Address (of Employer)
64. Position
65. Still Employed?
67. Date Employed
    Date Employed Start Date

    —

    Date Employed End Date
68. Name and Address (of employer)
69. Position
70. Still Employed?
74. References
    Give the names of three persons, not related to you, whom you know for at least one year.
76. Name
77. Phone Number
78. Business
79. Years Aquainted
81. Name
82. Phone Number
83. Business
84. Years Aquainted
86. Name
87. Phone Number
88. Business
89. Years Aquainted
93. I would like to serve on this board because:
95. Agreement*

    I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for appointment as may be necessary in arriving at an appointment decision. This application for appointment shall be considered active for a period of time not to exceed one (1) year. Any applicant wishing to be considered for appointment beyond this time should inquire as to whether or not applications are being accepted at that time.
    
    By submitting this form, I understand that I am submitting to a background check by St. Bernard Parish Government.
    
    

    1. I Agree
97. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
    
    

    1. I Agree
99. Signature of Applicant*
Leave This Blank:


101. 1. Receive an email copy of this form.
102. Email address

     This field is not part of the form submission.

103. Submit

* indicates a required field