Form Center

2. Select the Board, Commission, or Committee applying for*
   -- Select One --Select OneBoard of AssessorsBuilding Code Board of AppealsConservation CommissionDowntown TIF District Advisory BoardHeritage CommissionHighway Safety CommissionHistoric District CommissionLaconia Housing AuthorityLakeport TIF District Advisory BoardLibrary TrusteeLicensing BoardParks & Recreation CommissionPersonnel Advisory BoardPlanning BoardPolice CommissionPutnam FundTrustees of the Trust FundsWater CommissionWeirs TIF District Advisory BoardZoning Board of Adjustment
4. I am seeking appointment or reappointment as a:*
   -- Select One --Full memberAlternate member
6. Personal Information
8. First Name*
9. Last Name*
11. Address*
13. City*
14. State*
15. Zip Code*
17. Home Phone Number
18. Cell Phone Number
20. Work Phone Number
22. Email Address*
24. Please indicate below which items of personal information (if any) you DO NOT want released to the public
26. Residency Information
28. I reside in Ward
30. Length of Residency in City
32. Are you a registered voter

    1. Yes
    2. No
34. Are you currently serving on other City Boards, Commissions, or Committees?

    1. Yes
    2. No
36. If yes, which Board, Commission or Committee?
38. Conflicts of Interest
    Per RSA 673:7 and Chapter 5, Section 5-20 of the City Ordinances, a potential conflict of interest may exist if serving on more than one Board or Commission, as follows: Only one Planning Board member may be a member of the Zoning Board of Adjustment; either one appointed member or one ex-officio member of the Planning Board may be a member of the Conservation Commission; either one appointed member or one ex officio member may be a member of the Heritage Commission; a member of the Putnam Fund may not serve on the Trustee of the Trust Funds, and a member of the Trustee of the Trust Funds may not serve as a member of the Putnam Fund. For questions regarding conflicts of interest please contact the City Manager's Office at 527-1270, or email to NBrown@laconianh.gov
40. Please list below any experiences, skills and/or qualifications which you feel would especially suit you for this position, and your reasons for applying
44. Can you be objective, fair and impartial?*
46. Are you able to interpret and apply the New Hampshire Statutes as they pertain to Assessing?*
48. Are you willing to be available once per month for a Board of Assessors' meeting?*
50. In your family or professional life are you aware of any conflict of interest on Highway Safety issues, the Laconia Police Department or the receipt of grant funds by the City of Laconia that might unduly influence your decisions, or give the appearance of undue influence?*
52. Can you commit to attending meetings that are called on an as needed basis, with potentially only a few days' notice on occasion?*
54. Do you feel you can wait to weigh all of the information pertaining to an application before making a decision?*
56. Do you realize that decisions rendered at these meetings are not binding, but serve as a recommendation to the City Council, and that your decisions cannot be based on your personal feelings?*
58. What is the reason you have applied for this particular Board/Commission?*
60. What technical expertise or personal skill or interest would you bring to the Board/Commission?*
62. The Laconia Putnam Fund Advisory Committee advises the Trustees of the Trust Funds on the use of income from the Perley and Ellen M. Putnam Free Lecture Fund. Are you familiar with the Ellen M. Putnam Free Lecture Fund, or are you willing to do the research necessary to become familiar?*
64. Why do you feel bringing the arts into a community (to Laconia, specifically) is important and how do you feel Putnam Fund performances impact the City and its residents?*
66. The Putnam Fund's scope is to provide free entertainment to the citizens of Laconia. What do you see as the highest and best use for the funds in terms of types of performances offered and segments of the population that might be targeted?*
68. What do you feel are your qualifications for becoming a member of the Putnam Fund?*
70. What special talents, experience and/or interests would you bring to the group?*
72. Putnam Fund meetings are typically held one Friday a month at noon; will you be able to regularly attend meetings?*
74. In your family or professional life, would you have frequent conflicts of interest on cases before the Board/Commission that would require you to recuse yourself?*
76. Can you commit to attending the scheduled meeting(s) every month and possibly occasional extra meetings?*
78. Do you feel you can wait to weigh all of the information pertaining to an application before making a decision?*
80. Do you realize there are rules, regulations and laws to follow when making a decision on an application, and that it is not a decision based on your personal feelings?*
82. What is the reason you have applied for this particular Board/Commission?*
84. What technical expertise or personal skill or interest would you bring to the Board/Commission?*
86. Have you ever run a business?*
88. What would you do to increase library usage/# of visitors?*
90. What new, different programs/services would you offer?*
92. What do you think is the mission of a public library?*
94. How do you envision the Library serving the community moving forward?*
96. Will you be able to remain unbiased when reviewing all applications?*
98. Will you be available for not only the scheduled monthly meetings, but for unscheduled meetings as well?*
100. How would you handle a difficult applicant if their license was denied?*
102. What interests you about this position?*
104. What is it about your background, interests and knowledge that makes you a good candidate for the Parks and Recreation Commission?*
106. What ideas do you have for improving the park system in Laconia?*
108. Explain how you think the park system is beneficial to the community.*
110. What do you think are the major challenges that the Parks and Recreation Department is faced with at the current time and in the future?*
112. How do you feel about youth from surrounding communities participating in local youth sports organizations that utilize City of Laconia facilities?*
114. What type of recreation programs would you like to see that might not already exist?*
116. What is it about your background, interests and knowledge that makes you a good candidate for the TIF Advisory Board?*
118. What economic development opportunities do you feel exist in the TIF District?*
120. In what ways do you feel the TIF District can improve the community?*
122. Can you give some examples of potential TIF funded projects that you feel would be good for the economic development of the TIF District and the entire community?*
124. Which of the following criteria makes you eligible to be a TIF Advisory Board member: (Please see TIF District map)*

     1. Property owner in the District
     2. Resident of the District
     3. Own, manage or represent a business or organization in the District
126. What is your understanding of how TIF Districts work?*
128. What agencies or organizations are you currently (or have recently been) a member or participant?*
130. Are you available to attend daytime meetings?*
132. The function of a Trustee of Trust funds is to manage or supervise the management of assets held in Non-Expendable Trust Funds, Expendable Trust Funds and Capital Reserve Funds. As such, are you familiar with basic investment terms, such as income, principal, yield, return, equities, fixed income, asset classes, rebalancing, earnings per share, price/earnings ratio. If not, would you be willing to learn?*
134. Investments are to be invested in accordance with the provisions of New Hampshire laws. Are you familiar with these provisions or would you be willing to learn?*
136. The 4th Circuit Court - Probate Division authorized the Putnam Fund, one of the trust funds, to be administered according to the provisions in RSA 292-B (Uniform Prudent Management of Institutional Funds Act (UPMIF). Are you familiar with these provisions or would you be willing to learn?*
138. The Trustees have meetings four times a year in the morning (typically at 10:00 am). Would this prevent you from serving?*
140. The Trustees have a chairperson and a secretary. Would you be willing to serve in either of these offices if elected?*
142. Please explain why you feel that you should be appointed to the Board of Water Commissioners.*
144. What were the primary reasons that led you to apply for this Board vacancy?*
146. Are there any educational, work or life experiences that you believe will be helpful to your decision making process should you be chosen as a Water Commissioner?*
148. Do you foresee any circumstances that would restrict you from performing these duties?*
150. Electronic Signature Agreement*

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
152. Electronic Signature*
154. Date*
     Date
156. Oath of Office

     Please note that upon being appointed to any Board or Commission, applicants are required to be sworn in at the City Clerk's Office and sign an oath.

158. Questions?
     For general questions regarding this form please contact Nancy Brown in the City Manager's Office, 527-1270, or email NBrown@laconianh.gov
Leave This Blank:


160. 1. Receive an email copy of this form.
161. Email address

     This field is not part of the form submission.

162. Submit Submit and Print

* indicates a required field