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Boards/Commissions/Committees Application

  1. Number the committees listed below in order of interest for appointment, with 1 as the most interest and 6 as the least interest.

  2. 5-year term; meets as needed.

  3. 5-year term; meets as needed.

  4. 3-year term; meets as needed.

  5. 3-year term; meets every 2nd Tuesday of the month. Terms begin in July.

  6. 3-year term; meets every 3rd Thursday of the month.

  7. 5-year term; meets every 2nd and 4th Tuesday of the month.

  8. Personal Information*

    This form assists the Mayor and City Council in evaluating the qualifications of applicants for appointment to a board, commission or committee. State law requires political subdivisions to make a good faith effort to balance appointive boards, commissions, committees and councils authorized by the Code of Iowa according to gender.

  9. Please list your place of employment and/or activities such as hobbies, volunteer work, etc. that you feel may qualify you for this appointment.

  10. Please describe why you are interested in serving on a City of Waukee board/commission/committee.

  11. Please include any other information that supports your interest.

  12. What contributions do you feel you can make?

  13. Please provide at least two references who may be contacted on your qualifications for this appointment. Please include name, address, phone number, email address and your relationship to them.

  14. Signature*

    I certify that there is nothing that would prohibit me from serving on a City of Waukee board, commission or committee. My application will be retained for one year. This application is a public document and as such can be viewed, reproduced or distributed to the public.

  15. Leave This Blank:

  16. This field is not part of the form submission.