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Citizen Leadership Form

  1. 641 Plainsboro Road
    Plainsboro, NJ 08536
    Phone: 609-799-0909, ext. 2547
    Fax: 609-799-9204

  2. On October 19, 2009, Governor Corzine signed into law P.L. 2009, c.141 also known as the “Citizen Service Act,” which requires any person interested in serving on a municipal authority, board, commission or committee to file a 1-page “Citizen Leadership Form” with the municipal clerk and requires anyone newly appointed to a municipal entity to take an oath of office for that specific position.

  3. I hereby apply to perform public service on the following municipal authorities, boards, commissions or committees.

  4. Citizens appointed to serve on the Library Board of Trustees, Planning Board and Zoning Board of Adjustment are subject to the regulations of the New Jersey Local Government Ethics Law which requires the filing of a State mandated Financial Disclosure Statement every year.

  5. The information below is considered personal information, and is therefore deemed confidential for the purpose of P.L. 1963, c. 73 (C.47:1A-1 et seq.) and P.L. 2001, c. 404 (C.47:1A-5 et al.).

  6. Please list any education, prior volunteer experience, work related experience or other civic involvement which could be of use to the authorities, boards, commissions or committees which you listed above. Attach resume or additional background information.

  7. List dates and positions.

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