Commission/Boards Application

Tama County Commission/Boards Application Form

1. First Name
2. Last Name
3. Address
4. Address 2
5. City
6. State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
7. Zip
8. Home/Cell Phone
9. Work Phone
10. Email Address
11. On which commission/board are you asking to serve?
    Check all that apply
    Compensation Commission for Condemnation Proceedings
    Board of Health
    Conservation Board
    Civil Service Commission
    Veterans Affairs Commission
    Zoning Commission
    Board of Adjustment
    Board of Review
    Examining Board
    Assessor
    Compensation Board
    Magistrate Commission
    Magistrate Appointing Commission - Code of Iowa Chapter
    Hawkeye Valley Area Agency on Aging
    Region VI - Executive Board of Directors
    Pioneer Cemetery
    Central Iowa Tourism
    DHS Advisory Board
    Tama County Endowment Committee
    Conference Board
    Other
12. How did you hear about this opportunity?
    Check all that apply
    Tama County Email
    Tama County Website
    Newspaper
    Social Media
    TV
    Word of Mouth
    I Don't Remember
    Other
13. Please list any education, training, or experience you feel is relevant to the appointment you seek.

Your Signature

14. I certify that my answers are true and complete to the best of my knowledge.
15. I authorize investigation of all statements contained in the application. I understand that omission or misrepresentation of facts is cause for dismissal if this application leads to employment.
16. I consent to having this application and any accompanying documents treated as public records.
17. Signature Please type your full name to serve as an electronic signature.
18. Today's Date