KCMO Boards and Commissions Application


NEW APPLICANT FORM
  
Note:  Information submitted on this form and accompanying documents will be part of the public record.
Asterisks (*) denote required fields
  
    APPLICANT INFORMATION
*First Name:   *Middle Name:  
*Last Name:   Suffix:  
*Gender:     
    HOME ADDRESS INFORMATION
*Street Address:   *City:  
*State:   *Zip Code:  
*County:      
    BUSINESS ADDRESS INFORMATION
Street Address:   City:  
State:   Zip Code:  
County:   *Home Phone:  
*Mobile Phone:   Alt Phone:  
*Email Address:      
*Driver's License #:   *License State:  
*Council District:      Find your Council District  (new window)
  *Resident of Kansas City?     *How long have you lived in Kansas City?  
  *Do you intend to stay in Kansas City for the next 4 years?     *Voluntary consent to a background check  
    EXPERIENCE
*Current Occupation:   *Company:  
*Work Phone:   *Education:  
  *Degrees earned
 
  *Certification and other training
 
  *Other relevant skills
 
  *Volunteer experience & other community involvement for the past 10 years
 
  *Personal or technical organization membership for the past 10 years
 
  *Other relevant working experience
 
  *Other KC Boards and Commissions on which you have served or serve
 
  *Dates of service on other KC Boards and Commissions
 
    APPOINTMENT INFORMATION  (AREA/BOARD OF INTEREST)
  *How did you find out about this position?
 
*Board/Comm 1:      Board Descriptions  (new window)
Board/Comm 2:     
Board/Comm 3:     
Board/Comm 4:     
    VOLUNTARY DEMOGRAPHIC INFORMATION
  This information is requested to assist us in providing representation and to meet our goal of increased diversity within the membership of Kansas City's boards and commissions. We appreciate your response to these questions and your assistance with meeting our goal. Under state and federal law, this information may not and will not be used to discriminate against you.
Race:     
Sexual Orientation:   Disability:  
Party Affiliation:   Veteran:  
Age Group:      
    THREE REFERENCES
*Ref Name 1:   *Phone:  
*Ref Name 2:   *Phone:  
*Ref Name 3:   *Phone:  
    RESUME/OTHER INFORMATION
  •  Note: Please include an attachment of your resume or any other pertinent information for consideration.
   You also may attach a written document containing answers to the questions asked in this application.
   Any attachment must be a Microsoft Word or Acrobat (pdf) document.

•  Please use the File Attachment button to select your file.
File Attachment: