Retirement & Deferred Compensation Board Application

Personal Information

In order to be eligible for application, you must be at least 18 years of age, a U.S. citizen and a resident of Oakland County.

All qualified applicants receive consideration for appointment without regard to race, color, religion, sex, age, national origin, height, weight, familial, marital, handicap or veteran status.

Salutation

First Name

Last Name

Address

Address 2

City / Village / Township

Postal Code

Home Phone

Work Phone

Email

How long have you been a resident of Oakland County?

Are you an elector in Oakland County?

Are you a member of the Oakland County Retirement System or receive benefits under the system?

Do you hold any office or appointment with the County?

Explain why you would like to serve on the retirement & deferred compensation board:

Have you served previously on a board, committee or commission?

How long did you previously serve?

Please detail any work related or community service skills/experience you may contribute.

Have you ever been convicted of a misdemeanor or a felony?

Conviction Details

Date

Offense

Disposition

Education

High School or GED

City

State

College / Technical

City

State

Degree

Employment

Please list your most recent work experience first, including full, part-time and volunteer:

Employer

Address

Address 2

Position Title

Dates of Employment

Duties

References

In applying your signature to this application, you authorize the Oakland County Retirement & Deferred Compensation Board to contact those individuals or organizations you have listed as references.

Please List Contacts, Organizations & Phone Numbers:

Contact Person

Organization

Phone Number

Contact Person

Organization

Phone Number

I have answered all questions to the best of my ability. I have read all application disclaimers and authorize background inquiries as to my character, reputation and ability and release those supplying any information from liability.

Signature

Date

Contact Information