Questionnaire for Use in Conjunction with Appointment of

Oxford Township Committee Members

CONFIDENTIAL

Please provide your full name, residence (street address, city, state, zip code and county), business address, business, home and cellular telephone numbers and your email address.

Please append a copy of your resume if you refer to it in any of your responses to the questions below

  1. How long have you resided in Oxford Township?
  1. Are you registered to vote in Oxford Township? If so, what is your party affiliation, if any?
  1. Are you currently employed by, or do you receive any funding from, any state, federal or local government department, agency or institution (e.g., state and public colleges, county boards of elections, etc.)? If yes, please specify.
  1. Are you currently enrolled in or receiving benefits from a pension plan funded by the State of New Jersey, any municipality, or any other government entity in the State of New Jersey? If yes, please specify.
  1. Please identify all public or political offices, elective or appointive, sought or held. Include dates of candidacy or service.
  1. Are you related to any state, county or municipal employee or official, including individuals who serve on or employed by an, authority, fire district, other special district, board or commission? If yes, please provide the following: a. name; b. relationship; c. position held by relative.
  1. Are you currently employed, or were you employed during the last year, by any private sector entity that does or did business with the State, a county or municipality, authority, fire district or other special district, or board/commission? If yes, please provide the name and address of the private sector employer entity, the government entity with which it did business, and the nature of the business relationship.
  1. Do you or does any member of your immediate family have any ownership interest in any business enterprise that does business with the state (including any state boards/commissions), or any county,municipality, authority, fire district or other special district in New Jersey? If yes, please specify.
  1. Have you ever been arrested, taken into custody, charged with, indicted or tried for a crime or petty offense other than a traffic ticket? If yes, please provide details.
  1. Have you or any organization of which you were an officer, director or active participant, to your knowledge, ever been under investigation by any Federal, State or local agency for possible unlawful activity? If yes, please explain.
  1. Have you ever received a reprimand, censure, or been disciplined by a licensing or professional organization? If yes, please explain.
  1. Have you filed all federal and state tax returns when due, and are you current on all federal, state and local taxes and fees?
  1. Have you been involved in any litigation, either civil or criminal, as plaintiff or defendant? If so, please provide details including docket number and status.
  1. Please list all political, professional or social organizations with which you have been affiliated during the last 10 years, including any offices or leadership positions, and dates of service.
  1. Are properties that you own in compliance with all zoning ordinances and regulations?
  1. Please provide the web addresses of any websites and/or blogs that you maintain.
  1. Is there any information that, if revealed, would be embarrassing to you or the Administration? If yes, please specify.
  1. Please provide other information you regard as pertinent to your application for appointment.

Attestation: I understand that I have an affirmative and continuing duty to disclose all required information to the Governor’s Appointments Office, and that this duty continues until the effective date of appointment, should there be one. I understand that I have a duty to amend this questionnaire within 30 days of any occurrence that would change or render incomplete any answer contained herein, and to immediately notify the Governor’s Appointments Office of the impending change.