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2. APPLICATION FOR APPOINTMENT
   To Boards, Commission and Committees Advising the Story County Board of Supervisors
3. 
5. Date
   Date
7. Select the Board, Commission, or Committee applying for*
   -- Select One --Select OneAssessor's Examining BoardASSETBoard of AdjustmentBoard of HealthBoard of ReviewBooSTCivil Service CommissionCommission of Veteran AffairsCompensation BoardCondemnation Compensation BoardConservation BoardPlanning & Zoning Commission

   *Accepting only the following applications:

   1) ASSET Analysis of Social Services Evaluation Team)

   2) Board of Health - Due 3/20/26

11. *Only applicants for Planning and Zoning Commission and Board of Adjustment must answer the following 2 questions (needs to be "Yes" to be eligible):
13. 1) Are you an eligible elector?
    -- Select One --YesNo

    Iowa Code 39.3 (6) - https://www.legis.iowa.gov/docs/code/39.3.pdf 

15. 2) Do you reside outside of city limits in rural, unincorporated Story County?
    -- Select One --YesNo
19. Personal Information
21. First Name*
22. Last Name*
24. Home Address*
26. City*
27. State*
28. Zip*
30. Occupation*
32. Address at Work
34. City
35. State
36. Zip
38. Home/Cell Phone Number*
39. Business Phone Number*
41. Email Address
43. Education
47. List Names of Boards of Commissions in Order of Preference
49. Selection One
    -- Select One --Assessor's Examining BoardASSETBoard of AdjustmentBoard of HealthBoard of ReviewBooSTCivil Service CommissionCommission of Veterans AffairsCompensation BoardCondemnation Compensation BoardConservation BoardPlanning & Zoning Commission
50. Selection Two
    -- Select One --Assessor's Examining BoardASSETBoard of AdjustmentBoard of HealthBoard of ReviewBooSTCivil Service CommissionCommission of Veterans AffairsCompensation BoardCondemnation Compensation BoardConservation BoardPlanning & Zoning Commission
51. Selection Three
    -- Select One --Assessor's Examining BoardASSETBoard of AdjustmentBoard of HealthBoard of ReviewBooSTCivil Service CommissionCommission of Veterans AffairsCompensation BoardCondemnation Compensation BoardConservation BoardPlanning & Zoning Commission
53. Why do you wish to serve on this board?
55. What qualifications do you feel you have?
57. Do you have anything else to add?
59. Click Here to Upload Supporting Documents such as Resumes or DD-214s
61. THANK YOU FOR YOUR INTEREST IN SERVING STORY COUNTY.

    You will receive an invitation to interview following the CLOSE of the RECRUITMENT PERIOD. If you have any questions, please contact Sandra King, Director of External Operations and County Services at 515-382-7243.

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63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit Submit and Print

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