Get Public Board Member Application Form

The Public Board Member Application Form is a crucial document for individuals seeking to serve on public boards in Nebraska. This guide provides clear and step-by-step instructions to assist users in completing the form accurately and efficiently online.

Follow the steps to complete the application form with ease.

1. Press the ‘Get Form’ button to access the application form and open it in your preferred editor.
2. Enter your name in the designated fields for first, middle, and last names, and include any relevant credentials after your name.
3. Provide your mailing address, ensuring you fill out the street/box/RR, city, state, and zip code sections correctly.
4. Fill in your date of birth using the format day/month/year.
5. Input your business telephone, cell/pager number, and residence telephone in the corresponding fields.
6. Enter your email address and fax number if applicable.
7. Indicate your availability for monthly board meetings by selecting 'Yes' or 'No'.
8. Select how you became aware of the vacancy by checking the appropriate box.
9. Indicate your congressional district of residence by selecting the correct option and confirm your residency duration.
10. Respond to the eligibility questions regarding age, credential history, and familial connections to the board.
11. List your current and past involvement in community activities related to health care.
12. Indicate your preferences for the boards you are interested in serving on.
13. Complete the education section by stating your school, location, degree/specialty, and completion date.
14. Fill out the work experience section, listing your most recent position first, including hours worked, type of experience, and dates.
15. Provide any additional information regarding your interest in the board and any potential conflicts of interest.
16. Affirm the information provided by signing and dating the form.
17. Once complete, save your changes, and you may download, print, or share the filled form as needed.

Complete your application online to take the next step in contributing to public service.