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Louisville Metro Boards and Commissions Application Form 

Information provided on this form will be a public record subject to free and open examination by any person under the Kentucky Open Records Act. 

Name:
* *  
Primary Phone
At least one phone number is required.
The selected Primary phone must be filled in below.
Home Phone Business Phone
Cell Phone
E-mail
*Street:
CityStateZip Code
Employer
Profession/Occupation
Interests PC users: To select multiple Interests, click each one as you hold down the Ctrl key.
MAC users: To select multiple Interests, click each one as you hold down the Shift key.
 
Which Boards you would like to apply for?
Volunteer Activities
Past Service on City and County Boards and Commissions?  
If Yes, Please List
 
Please answer the following questions. If you answer yes, please include relevant details (i.e. position, company, address, dates, etc.) in the Additional Notes section below.
Are you employed by Louisville Metro Government?
Do you or a member of your immediate family have ownership interest in any company that does business with Louisville Metro Government?
Do you or a member of your immediate family have ownership interest in any property that is the subject of a condemnation proceeding, planning and zoning proceeding or any other administrative or court proceeding in which Louisville Metro Government or its agencies are interested parties?
Do you have any contract or matter pending before any Louisville Metro Government agency?
Have you ever been sued by the former City of Louisville, Jefferson County or Louisville Metro Government?
Have you ever been convicted of a felony offense?

Additional Notes


Some boards and commissions require membership to be racially, politically or geographically proportionate to the general public. Please complete the information requested below.
*Race *Gender
*Date of Birth
Use Format: MM/DD/YYYY
*Party Registration
Louisville Metro Council District   
     
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