APPLICATION FORM FOR WOODBURY COUNTY
BOARD/COMMISSION
Please Return To:
Woodbury County Board of Supervisors, Room 104, Woodbury County Courthouse,
620 Douglas St., Sioux City, Iowa 51101
Phone: (712) 279-6525 Fax: (712) 279-279-6577
Application For: ______________________________________ (Board/Commission)
Date ________________________________ E-mail Address ___________________________________
Name __________________________________________________________________________________
Address ________________________________________________________________________________
Phone Number ______________________________ Fax Number _______________________________
Business Phone _____________________________ Cell Phone _________________________________
This form assists the Board of Supervisors in evaluating the qualifications of applicants for appointment to a board or commission. State law requires
political subdivisions to make a good faith effort to balance most appointive boards, commissions, committees, and councils according to gender by
January 1, 2012, and each year thereafter.
Female Male
Place of employment and position (and/or activities such as hobbies, volunteer work, etc. that you feel
may qualify you for this position):
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The following questions will assist the Board of Supervisors in its selection.
▀ How much time will you be willing to devote in this position?
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▀ Interest in Appointment: Describe in detail why you are interested in serving on a county board or
commission. Include information about your background that supports your interest.
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▀ Contributions you feel you can make to the Board/Commission:
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Website: www.woodburycountyiowa.gov