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2. Date
   Date
4. Last Name
5. First name
6. Middle Initial
8. Home Address
10. City
11. State
12. Zip Code
14. Is your primary residence with in the city limits of Marshalltown?

    1. Yes
    2. No
16. Day Phone
17. Evening Phone
18. Cell Phone
20. Employer
    If retired, please indicate last employer and position held.
22. Email
23. Veteran's Status

    1. Yes
    2. No
25. Organization Interest

    Please check which of the following City Boards and/or Commissions you would like to be appointed to.

    1. Board of Adjustment
    2. Building Board of Appeals
    3. Civil Service Commission
    4. Electrical Appeal Board

    1. Fire Code Board of Appeals
    2. Investment Committee
    3. Library Board of Trustees
    4. Parks & Recreation Advisory Committee

    1. Plan & Zoning Commission
    2. Solid Waste Commission
    3. Storm Water Advisory Committee
    4. Water Works Board of Trustees
27. Are you apply for reappointment?
    -- Select One --YesNo
29. Volunteer Civic / Community Activity:

    Please list the organizations in which you have been involved, the nature and duration of your involvement, and any offices or positions you have held.  Include any innovative programs you have developed or participated in at work or in other volunteer capacities.  If preferred, you may upload a document with this information.

31. Please indicate why you have designated a particular Board/Commission on which you would like to serve.
33. Additional Information Upload
34. Please attach a resume, if applicable, to evaluate your interests and match you with the appropriate Board/Commission vacancy.
36. Attendance of Members of All Boards and Commission

    To ensure the effective operation of our Boards and Commissions by promoting accountability and regular attendance among its members while aligning with the statutory provisions established by the State of Iowa law, if any commission member has three (3) unexcused absences at six (6) consecutive meetings of the Commission, such absences shall be grounds for requesting the member’s resignation.  An unexcused absence is an absence without prior approval or a valid, document reason. If the member does not voluntarily resign following such request, the Mayor may initiate proceedings for removal of the member in accordance with Iowa Code § 372.15.

38. Please list any days or times you are not available for meetings:

40. The City appreciates your time and volunteer spirit. Your application will be kept on file for one year. Please subscribe to City News to receive volunteer opportunity announcements https://www.marshalltown-ia.gov/list.aspx.

42. Applicant's E-Signature

    Please note that this application is considered a public record.

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44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit Submit and Print

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