Hardin County, IA

Application for Appointment to Boards, Commissions & Committees

1. Applicant This section is complete This section is incomplete
2. Qualifications & Background This section is complete This section is incomplete
3. References This section is complete This section is incomplete
4. Verification This section is complete This section is incomplete

Application For*
Please indicate which board, commission, or committee for which you are applying.
Date*
Date
Name*
Phone*
Email
Mailing Address*
Gender Balance*
This form assists the Board of Supervisors 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 most appointive boards, commissions, committees, and councils according to gender by January 1, 2012, and each year thereafter.
1. Female
2. Male
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The following questions will assist the Board of Supervisors in its selection process.
Place of employment and position (and/or activities such as hobbies, volunteer work, etc., that you feel may qualify you for this position:
Why do you wish to serve on this board, commission, or committee?
What do you feel is your biggest contribution to this board, commission, or committee would be?
What direction or role do you perceive of this board, commission, or committee?
What other meetings or conflicts do you have which would prevent you from attending meetings?
Do you have any additional comments to add that may assist the Board of Supervisors in its selection?
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Please provide two references who may be contacted on your qualifications for this position.
1. Name*
Phone*
Relationship*
Address*
Email*
2. Name*
Phone*
Relationship*
Address*
Email*
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Your application will be retained by the Hardin County Board of Supervisors for one year from the date of application. This application is a public document and, as such, can be reproduced and distributed for the public.
Electronic Signature of Applicant*
1. Selecting this option certifies that there is nothing that would prohibit me from serving on this board, commission, or committee and indicates understanding of the application process.

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