Peter Whalen,} �N� Mayor of Northampton Mass. <mayor@northamptonma.gov>
Online Form Submittal: Application for Appointment to Boards, Committees and
Commissions
noreply@civicplus.com <noreply@civicplus.com> Wed, Oct 19, 2022 at 2:04 PM
To: mayor@northamptonma.gov
Application for Appointment to Boards, Committees and
Commissions
City of Northampton Application for Appointment to Boards, Committees, and
Commissions
Please return the completed form to: mayor@northamptonma.gov or Gina -Louise
Sciarra, Mayor 210 Main Street, Northampton, MA 01060
Boards and Committees
First Name
Last Name
Title/ Preferred Pronouns
Addressl
Address2
City
State
Zip
Home Phone
Work Phone
Cell Phone
Occupation & Place of
Fmnlovment
cmau
Are you a Northampton
resident?
Years Lived in Northampton
Age
Other
r-eUer
Whalen
Field not completed.
35 Norfolk Ave.
Field not completed.
Northampton
Massachusetts
01060
14135750865
4135861000
14135750865
Insurance/Whalen Insurance
peter@whaleninsurance.com
Yes
Sex
Male
Racial / Ethnic Background
Please list 'other" board or
committee of interest
What skills and experience
will you bring to this
committee assignment?
Are you currently serving or
have you served on any city
committee?
Please list other city
committees you have served
on
White
Elected Officials Compensation Advisory Board
Business owner, employer and long term citizen
No
ARPA
Required: Please read the following, by signing below you state that you understand
and agree.
The filing of this form does not guarantee my appointment. An application is kept on
file for two (2) years; after that I must file a new application. Being appointed to a
committee, board, or commission means that I am considered a Municipal
Employee under MGL Chapter 268A and thereby subject to Conflict of Interest Law
MGL Chapter 268A, Financial Disclosure Law MGL Chapter 268B, as well as Open
Meeting Law MGL Chapter 39: Section 23B. 1 understand that 1 will take the conflict
of interest test after being appointed and that I also must be sworn in by the City
Clerk. 1 will contact the appointing authority with any questions about my service.
Important: Once this form is submitted it becomes a public document, if there is
information you do not want open to the public please do not include it on this form.
Signature
Peter J. Whalen
Date 10/19/2022
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