Application for Appointment

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Application for Appointment

Stutsman County is an Equal Opportunity Employer

We consider applications for all positions without regard to race, gender, creed, religion, sexual orientation, national or ethnic origin or any other legally protected status.

Complete the entire application. If you fail to complete all questions your application will be deemed incomplete and may be rejected.

Date*

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Board Applying For:*

Full Name*

First Middle Last

Address*

Street

City

State

ZIP

Phone (Home)

Phone (Work)

Phone (Mobile)

Email Address*

Email Address

How do you prefer we contact you?*

Phone (Home)

Phone (Work)

Phone (Mobile)

E-mail

Are you a resident of Stutsman County?*

Occupation*

Please give a brief description of your background and experiences that you feel would be an asset to serving if appointed:*

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Have you ever served on any other type of board?*

If Yes, what boards?*

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Could you regularly attend board meetings as presented on the position description?*

What is your interest in this organization?*

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Are you aware of any conflicts of interest that you may/or could have with serving in the position for which you are applying? If so, please explain the situation.*

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Do you own or have any interest in any property in Stutsman County? If so, please provide address(es) and/or legal description(s).*

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Submit Application

PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.

By digitally signing or typing your name into the Applicant Signature box below, you are confirming that the above statements are true. You agree that you are electronically signing this document.

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Name

Date*

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Prove you are a human

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Your application has been successfully submitted.