Application For Committee or Board Appointment

By submitting this application, I understand that any misrepresentation of the information I have provided could result in my non-selection as a board/committee member. I understand that the information I have provided and the contents of my background report may be disclosed to authorized employees, officials, and/or duly accredited representatives of Montgomery County as necessary throughout the applicant selection process. I hereby release Montgomery County and any individual, including records custodians, from any liability for damages of whatever kind or nature which may at any time result to me on account of compliance or any attempt to comply with this authorization.