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Kansas City, Missouri Boards and Commissions Application Form

Note: Information submitted on this form and accompanying documents will be part of the public record

APPLICANT INFORMATION
 
  Asterisks (*) denote required fields
 
*First Name
*Middle Name
*Last Name
 
Suffix
 
Home Address Information
*County *Address (Street Address only. No P.O. Box)
 
*City *State *Postal Code
 
Business Address Information
County Address (Street Address only. No P.O. Box)
 
City State Postal Code
 
*Home Phone *Mobile Phone
 
Alternate Phone *Email Address *Resident of Kansas City
 Yes     No
 
*Driver's License Number *State of Driver's License Issuance *Your Council District
 
*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
 Yes     No  Yes     No
 
EXPERIENCE
 
*Current Occupation *Company Name *Work Phone
 
*Education level *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)
 
Board/Commission 1  
* Selected Board Information
(opens new window)
 
*Describe your interest in this Board/Commission  
 
 
 New     Reappointment  
 
Board/Commission 2  
 
 
Describe your interest in this Board/Commission  
 
 
 New     Reappointment  
 
VOLUNTARY DEMOGRAPHIC INFORMATION
       
Race Sexual Orientation Disability Veteran
 Yes     No
 
Party Affiliation Age Group
 
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.
 
THREE REFERENCES
   
*Reference Name *Phone
 
*Reference Name *Phone
 
*Reference Name *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 document.
  • Please use the Browse button to select your file.
File Attachment