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2. Date
   Date
4. Last Name
5. First name
6. Middle Initial
8. Street Address
10. City
11. State
12. Zip Code
14. Day Phone
15. Evening Phone
16. Cell Phone
18. Employer
    If retired, please indicate last employer and position held.
20. Email
22. Gender Balance

    Iowa Code 69.16A requires all appointive boards, commissions, committees, and councils are gender-balanced. Please indicate how you identify. 

23. Veteran's Status

    1. Yes
    2. No
25. 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.

27. Additional Information Upload
29. 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
    5. Fire Code Board of Appeals

    1. Housing Advisory Board
    2. Investment Committee
    3. Library Board of Trustees
    4. Parks & Recreation Advisory Committee

    1. Plan & Zoning Commission
    2. Solid Waste Commission
    3. Water Works Board of Trustees
    4. Other
31. If other, please explain:
33. Please indicate why you have designated a particular Board / Commission on which you would like to serve:
    For instance, previous experience, expertise or interest, improvements, etc., you believe you would bring to the Board / Commission.
35. Attendance of Members of All Boards and Commission
    Attendance of Board and Commission members will be reviewed on a quarterly basis by the staff member who works most directly with any Board or Commission. If attendance of any member is at a level of less than 75% for two consecutive quarters, the staff member will report that attendance to the member and to the Mayor. If attendance of any member is at a level below 60% in any four consecutive quarters (or over a span of six or more meetings for groups which meet fewer than six times annually), the Mayor will request a resignation from that member unless there were extenuating circumstances, outside the control of the member, which were reported to the staff member prior to the absences. If a Board or Commission has been unable to conduct business at more than one scheduled meeting in the previous year due to lack of a quorum, the 60% requirement will be enforced regardless of extenuating circumstances.
37. I do not intend to leave the city for long periods of time during my appointment:

    1. Yes
    2. No
39. If you have a resume, please attach it to this form so that the Mayor and City Council can most effectively evaluate your interests and match you with the appropriate Board / Commission vacancy.

41. 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.

43. Applicant's E-Signature
45. Meeting notifications are provided via email and posted on the City’s website.
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit Submit and Print

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