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2. First Name*
3. Last Name*
5. Home Phone*
6. Cell Phone*
7. Business Phone
9. Email Address*
10. Current Address*
12. Years in Flossmoor*
13. Prior City/State Address*
15. Board/Commission(s) Applying For*

    1. Community Relations Commission
    2. Green Commission
    3. Electrical Commission
    4. Plan Commission
    5. Police and Fire Commissioners Board

    1. Police Pension Board
    2. Fire Pension Board
    3. Public Art Commission
    4. Zoning Board of Appeals
17. Qualifications For Desired Board/Commission*
19. Educational Background*
21. Occupational Experiences*
23. Professional Affiliations*
25. Have You Held Other Positions With the Village of Flossmoor?*

    1. Yes
    2. No
26. Duration*
28. Have You Held Positions With Other Municipalities, School Districts, Park Districts, etc.?*

    1. Yes
    2. No
29. Duration*
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31. Submit

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