BOROUGH OF AMBRIDGE 600 Eleventh St. Ambridge, Pa 15003  STATEMENT OF QUALIFICATIONS APPOINTMENTS, BOARDS & COMMISSIONS  NAME: ADDRESS:  HOME PHONE: WORK PHONE: CELL PHONE: POSITIONI AM INTERESTED IN: REASON FORI MY INTEREST:  QUALIFICATIONS:  BY SIGNING THIS APPLICATIONICERTIFY THAT ALL INFORMATION GIVEN IS TRUE AND CORRECT AND THATIGIVE PERMISSION FOR TO HAVE BACKGROUND CHECK. IUNDERSTAND THAT ANY  FALSE INFORMATION GIVEN WILL DISQUALIFY ME.  SIGNATURE OF APPLICANT  DATE