VOLUNTEER BOARDS & COMMISSIONS APPLICATION

VOLUNTEER BOARDS & COMMISSIONS APPLICATION

CITY OF POLK CITY, IOWA
The City of Polk City has a variety of volunteer opportunities on boards and commissions for the following purposes:
- advise the City Council
- hear and make decisions on appeals and variances
- assist in the planning of parks, recreational programs, land use and zoning, and operations
- assist in the promotion of educational, cultural, economic and general welfare of the public
- assist in the promotion of performing and fine arts programmingassist with management of library services.
All board and commission members must be Polk City Residents. Applicants are appointed by the Mayor and confirmed by the City Council. Terms for the boards and commissions vary and are established by the Municipal Code. All meetings of the boards and commissions are open to the public and agendas are prepared and available for public viewing.

For more information, contact the City Clerk’s Office by phone at 515-984-6233 or e-mail support@polkcityia.gov.
APPLICANT INFORMATION
Name*

First NameMiddle InitialLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Employer Name*
Job Title*
Length of residency in Polk City*
Library Board of TrusteesPlanning and Zoning CommissionPark CommissionBoard of AdjustmentTree BoardOther
What knowledge and/or understanding of the Board/Commission do you have?*
Financial ManagementLand Use PlanningCommunity GroupsEngineeringConflict ResolutionOther
What education, experiences or activities qualify you for this volunteer position?*
Why do you wish to serve on the Board or Commission?*

Please indicate:*

Rows	Yes	No
Would you be able to attend regularly scheduled meetings?
Do you sell, contract or furnish supplies, material or labor to the City?
Have you ever been employed by the City?
Do you have any relatives working for the City?

Reference 1*
Please list name, contact information, and relationship
Reference 2*
Please list name, contact information, and relationship
Reference 3*
Please list name, contact information, and relationship
Signature*

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VOLUNTEER BOARDS & COMMISSIONS APPLICATION

APPLICANT INFORMATION