City of Des Moines Application for Appointment to Board, Commission, or Committee
First Name:
Middle Name:
Last Name:
Prefix (Mr./Mrs./Ms.):
Address 1:
Address 2:
City:
State:
Zip:
Occupation:
Occupation Duration:
Employer:
Employment Duration:
Business Address 1:
Business Address 2:
Business City:
Business State:
Zip:
Business Telephone:
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Business Fax:
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Residence Telephone:
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Alternate Telephone:
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Birth Date:
Des Moines Resident
Ward:
Residency Duration
Registered Voter:
Previous City Employment:
City Employed Relatives:
Have you ever served on ANY Board, Commission, or Committee?
List Boards, Commissions and Committees and Date(s) served:
List Boards, Agencies, Civic, Service and/or Professional Organizations to which you are affiliated:
Indicate other experiences or skills which will contribute to the mission of this Board, Commission or Committee:
Indicate up to 5 Board, Commission, or Committee's you would like to serve.
Neighborhood Revitalization Board requires completion of separate application.
Comments:
Email Address:
