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Colerain Township Boards and Commissions Application

  1. The information from this application will be used exclusively by the Colerain Township Administration Office. Colerain Township, Ohio is an equal opportunity employer and will not use any of the information you provide to discriminate against you on the basis of race, color, religion, sex, national origin, handicap, age, or ancestry.

    Please note that this form with your answers is subject to public disclosure under the Ohio Open Records Law, subject to certain redaction permitted by law. If you need more space to answer any question or explain any of your answers, please use additional sheets. Please type or print clearly. This information must be completed in full.

    Answer “none” or “not applicable” where appropriate. Attach résumé, if available. Colerain Township Board and Commissions members are required to be electors (registered voters) of Colerain Township, Ohio.

    Mail application to:
    Colerain Township Administrator
    4200 Springdale Road
    Colerain Township, OH 45251

  2. Are you a registered voter in Colerain Township, Ohio?*

  3. Please upload your resume, if applicable.

  4. Education & Training

  5. Did you graduate?*

  6. Did you graduate?

  7. Did you graduate?

  8. Specify Preferred Mailing Address*

  9. Do you currently or have you previously served on a Colerain Township appointed Board or Commission?*

  10. Are you applying for reappointment to a Board or Commission on which you currently serve?

  11. Are you currently in arrears on any court-ordered child support payments?*

  12. Have you been publicly identified with a controversial national, state, or local matter related to any issue that may be presented before the Board(s) or Commission(s) to which you are applying?*

  13. Have you ever submitted oral or written statements to any government authority or the news media on topics related to any issue that may be presented before the Board(s) or Commission(s) to which you are applying?*

  14. Do you own real property, personal property, financial holdings or receive income from any source which might present a potential conflict of interest or appearance of conflict of interest with your requested appointment?*

  15. Within the past three years, have you been assessed a penalty for failure to file a timely federal, state or local personal income tax return or for failure to pay taxes owed?*

  16. Within the past three years, has any business venture for which you were a person responsible for remitting withholding taxes or sales taxes, failed to pay such taxes in a timely manner?*

  17. Please Note: The Northwest Local School District and Colerain Township are regularly involved and overlap jurisdiction of Colerain Township in addition to being involved in shared services such as police protection.

    I certify that all of the answers and statements on this form are true, complete, and correct to the best of my knowledge and are made in good faith.

  18. Leave This Blank:

  19. This field is not part of the form submission.