Application For Appointments To Storm Lake Boards & Commissions

2. City of Storm Lake
   P.O. Box 1086, 620 Erie St Phone 712-732-8000

   P.O. Box 1086, 620 Erie St Phone 712-732-8000

3. 

4. APPLICATION FOR APPOINTMENTS TO STORM LAKE BOARDS & COMMISSIONS

6. First Name*

7. Last Name*

9. Address1*

11. City*

12. State*

13. Zip*

15. Primary Phone #*

16. Other Phone #

17. Business Phone #

18. E-mail Address*

20. Preferred Method of Communication?*

    1. Call
    2. Text
    3. E-mail

21. How long have you lived in Storm Lake?*

22. Employer*

23. Occupation*

25. List any volunteer/civic/community activity in which you have been involved:

27. Please check the following City boards or commission to which you would like to be appointed:*
    -- Select One --ADA Compliance CommissionAirport CommissionBand TrusteesBoard of Adjustment (5 yrs)Cemetery BoardCivil Service Commission (4 yrs)911 Board ( no specific term)Board of AppealsLibrary Board (6 yrs)Landfill CommissionPlanning & Zoning CommissionStorm Water AdvisoryMayor's Committee on Trees, Trails, ParksMayor's Advisory Committee Parks, Trails & Urban Forest

    All of the boards & commissions have a 3-year term unless otherwise stated.

29. Why do you want to serve on this board or commission?*

31. In accordance with Iowa Code Chapter 362 the City must determine what relationships or transactions you may have or potentially have with the City of Storm lake prior to your appointment to a Board or Commission. In order to do this we must ask you to answer the following questions.

33. Do you or any immediate family member own or are part owners of a business dong business with the City of Storm Lake?*

    1. Yes
    2. No

35. If so, name of the business and the percentage you or immediate family member own?

37. Are you employed by any business dong business with the City of Storm Lake?*

    1. Yes
    2. No

39. If Yes:

40. What is the name of the Business:

42. Is your salary/bonus determined by financial performance of the company or do you receive a commission?*

    1. Yes
    2. No

44. I certify that above answers are correct and true.

46. Signature*

47. Date
    Date

49. "Appointment to City Boards and Commissions are made by the Storm Lake Mayor and confirmed by the City Council."

Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit

* indicates a required field