2. Name:*
4. Address:*
6. Phone Number: Home/Cell*
8. Work Phone Number:
10. Email Address*
12. BOARD OR COMMISSION PREFERENCE: (List first, second, and third choices)
14. 1st Choice*
    -- Select One --Airport Advisory BoardAnimal Control CommissionBoard of AdjustmentConstruction Appeals BoardCultural AffairsHistoric PreservationHousing AuthorityLibrary BoardMarland EstatePark & Recreation BoardPersonnel BoardPlanning CommissionSenior Advisory Board
16. 2nd Choice
    -- Select One --Airport Advisory BoardAnimal Control CommissionBoard of AdjustmentConstruction Appeals BoardCultural Affairs BoardHistoric PreservationHousing AuthorityLibrary BoardMarland EstatePark & Recreation BoardPersonnel BoardPlanning CommissionSenior Advisory BoardNone
18. 3rd Choice:
    -- Select One --Airport Advisory BoardAnimal Control CommissionBoard of AdjustmentConstruction Appeals BoardCultural Affairs BoardHistoric PreservationHousing AuthorityLibrary BoardMarland EstatePark & Recreation BoardPersonnel BoardPlanning CommissionSenior Advisory BoardNone
20. Occupation:*
22. How Long Have You Lived in Ponca City?*
24. What Civic activities have you been or are now involved in?*
26. To what extent have you been or are now involved in City Government?*
28. Do you currently serve on any City Board/Commission or any Business Board / Committee that is not associated
    with the City?*

    1. Yes
    2. No
30. If Yes please list:
32. Comment on why you wish to be appointed to a City Board or Commission.*
34. How much time are you willing to devote to the duties of the position for which you are applying?*

    1. 1 Hour/ Week
    2. 2 Hours/Week
    3. 1 Hour/Month
    4. 2 Hours/Month
    5. More
36. References:
38. Name:
    Address:
    Occupation:*
40. Name:
    Address:
    Occupation:*
42. Name:
    Address:
    Occupation:*
44. Date:*
46. Signature:*
48. Mail form to: City Manager, City of Ponca City, PO Box 1450, Ponca City, OK 74602-1450 or Submit online.
Leave This Blank:


50. Submit Submit and Print

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