Candidate Form — Elkhorn Suburban Fire District #2

Printable Form

ELKHORN SUBURBAN FIRE PROTECTION DISTRICT NO. 2

Online Candidate Form for Appointment to Board of Directors to Fill Vacancy for the Unexpired Term Ending in 2022

Name

First Name

Last Name

Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Information the Candidate would like to share

(i.e. education, career, other Boards, community involvement, etc. – optional):

Reasons for wanting to be on the Board

Optional

References

Optional

Electronic Signature (Print Name)

The completion and submittal of this Candidate Form to fill the vacancy on the Board of Directors of the Elkhorn Suburban Fire Protection District No. 2 is optional. Upon completion of this form, so long as the person resides within the District, their name will be placed on the ballot for appointment to be submitted to the Board of Directors at their meeting of May 9, 2019. This is for information purposes only. The candidate may request that their name be submitted to the Board of Directors to be considered to fill this vacancy at any time prior to or at the meeting up until the time the Board closes nominations and votes by contacting Jim Lang, District Attorney, at (402) 330-1900 or jlang@langlawllc.com. Please submit the completed form prior to May 9, 2019.