Form Center

2. Applicant Information
4. First Name
5. Last Name
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Email Address
16. Employer Information
18. Employer Name
20. Business Address
22. City
23. State
24. Zip Code
26. May personal and business information be included in publications released for public viewing?

    1. Yes
    2. No
28. This form assists the City in evaluating the qualification of applicants for appointment to a board or commission. State law requires political subdivisions to make a good faith effort to balance appointive boards and commissions and authorized by the Code of Iowa according to gender.

    1. Male
    2. Female
30. How long have you been a resident of Ankeny?
32. I am interested in serving on:

    1. Board of Examiners and Appeal
    2. Civil Service Commission
    3. Cultural Arts Board
    4. Economic Development Council
    5. Human Rights Commission

    1. Library Board of Trustees
    2. Park Board
    3. Plan and Zoning Commission
    4. Polk County Aviation Authority
    5. Zoning Board of Adjustment
34. Area of Knowledge and/or Expertise

    1. Building Construction
    2. Community Groups
    3. Computers
    4. Engineering
    5. Financial Management

    1. Graphics
    2. Land Use Planning
    3. Pension Fund
    4. Real Estate
    5. Other
36. If "Other", please specify:
38. What knowledge/understanding of the board/commission do you have?
40. What experiences/activities qualify you for this position?
42. Why do you wish to serve on the board/commission?
44. Would you be able to attend regularly scheduled meetings?

    1. Yes
    2. No
46. Do you sell to, or are you in any manner part to, any contract to furnish supplies, material, or labor to the City of Ankeny?

    1. Yes
    2. No
48. If "Yes", please list.
50. Have you ever been employed by the City?

    1. Yes
    2. No
52. If "Yes", please list dates of employment and positions held.
54. Do you have any relatives working for the City?

    1. Yes
    2. No
56. If "Yes", please provide the employee's name and your relationship to them.
58. References
60. Reference 1
61. Address
63. Reference 2
64. Address
66. Reference 3
67. Address
69. If you are not selected for a position, do you wish to have your application retained on file?

    1. Yes
    2. No

    If not selected, your 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.

    In applying for an appointment, you understand the City Council may make inquiries in the community pertinent to your appointment.

    Typically new appointments will be made in January. Notification to all applicants will be completed by Jan. 31.

    If you have questions, please contact the City Clerk at 515-965-6405.

Leave This Blank:


71. 1. Receive an email copy of this form.
72. Email address

    This field is not part of the form submission.

73. Submit

* indicates a required field