MSGenWeb CC Application
Thank you for your interest in caring for one of our county websites. Please complete the application form and submit it.  All required questions must be answered and required contact information must be filled out completely.  Applications with blank questions or incomplete contact information will not be considered. Please allow approximately seven (7) working days for a response.  
What is your name? *
What specific county are you interested in? *
Please list county or type "optional".
What are your ties to this county or to this state?, Please explain: *
What acces do you have to records & documents for this county or for the state? *
What position are you applying for? *
County Coordinator (CC) or Assistant County Coordinator (ACC)
Required
Do you own any of the following programs? *
If you don't have any, most are freely available
Required
Do you have experience with the following? *
Choose all that apply:
Required
Briefly explain you web design or maintenance experience: *
Please include links/URL's to your website/s
USGenWeb Experience *
Are you currently serving or have you previously served as a County Coordinator or Assistant County Coordinator in any USGenWeb State Project or Special Project?
Required
Is yes, where? *
What is your address? *
What city? *
What state? *
What is your zip code? *
What is your primary email address? *
What is your alternate email address? *
What is your home telephone number? *
What is your alternate telephone number (work or cell). *
Personal or Professional References *
Please provide the names and contact information (address and phone number) for two(2) personal and/0r professional references whom you have known or worked with for a minimum of 1 year.
Authorization and Release *
I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the organization, my former employers & all other persons, corporations, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation.
Required
I understand *
The MSGenWeb Project at USGenWeb is required to maintain a list of members names, phone numbers and email addresses for their records.
Required
Signed (Type your name in the box below) *
I certify that the information on this application is correct and I understand that any misrepresentation or omission of any information will result in my disqualification from consideration or, if already accepted, my immediate dismissal. I permit the USGenWeb MSGenWeb Project to examine my references and verify any other information I have provided.
Date *
(Transmission of this document to the USGenWeb MSGenWeb is your electronic signature)
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