Application For Appointment To A St. Charles County Board or CommissionIn selecting members for the various boards and commissions in St. Charles County, the County Executive and the County Council try to identify individuals with a conscientious commitment to the betterment of the community and a reputation of fairness and integrity. The questions on this form are asked to provide information so that boards and commissions are composed of a proper demographic reflection of the County's population.
Are you a registered voter?
Council District Number
Length of residence in St. Charles County?
Do you live within the boundaries of a municipality?
If so, which municipality?
Lake Saint Louis
Portage Des Sioux
Weldon Spring Heights
Board or appointment desired: (hold ctrl key to select multiples)
Board of Equalization
Board of Zoning Adjustment
Commission on Environmental Quality
Community & Childrens Resource Board
Community Assistance Board
Developmental Disabilities Resource Board
Domestic Violence Board
Duckett Creek Sanitary Sewer District Board
Flood Plain Vision Board
Historical Advisory Board
Industrial Development Authority
Local Emergency Planning Committee
Master Plan Steering Committee
Merit System Commission
Mid-East Agency On Aging
Parks & Recreation Advisory Board
Planning & Zoning Commission
Regional Solid Waste Management Advisory Board Road Board
St. Charles City-County Library Board of Trustees
St. Charles County Road Board
St. Charles County Transit Authority
St. Charles County Weed Control Board
St. Louis Metropolitan Park & Recreation District
Workforce Development Board
Place of employment
Occupation and brief description of job responsibilities
Educational background (post-secondary)
Experience or credentials related to the position sought
Community, voluntary, or religious organizations in which you have been active
Have you previously served on a board or commission?
If yes, specify
Do you currently serve on any boards or commissions?
If yes, specify:
Have you ever held elected or appointed office?
Sources of family income (spouse included) - employer names and that of spouse's, or if self-employed, please state business (not amounts received)
Why do you wish to serve on the board?
DISCLOUSURE STATEMENT(Addendum to Application for Appointment to County Boards and/or Commissions)
1. Are you related by blood or marriage to the county executive, a member of the county council or any other elected official, officer or employee of St. Charles County Government or of any political subdivision within St. Charles County or, if applicable, of any director or officer of the entity to whose board, commission, or governing body you seek to be named?
If your answer is yes, please identify the person or persons, by whom they are employed and the nature of your relationship.
2. Are you a director, officer, sole owner, partner or employee of or consultant or advisor to any business enterprise which to your knowledge or belief supplies any property, goods or services to St. Charles County Government or, if applicable, to the entity to whose board, commission or governing body you seek to be named?
If your answer is yes, please identify such enterprise and describe your relationship with it.
3. Do you or any member of your family have any direct or indirect financial interest in any business enterprise which to your knowledge or belief supplies any property, goods or services to St. Charles County Government or, if applicable, to the entity to whose board, commission or governing body you seek to be named?
4. In the past 12 months, have you participated in or assisted in any transaction between any business enterprise and St. Charles County Government or, if applicable, with the entity to whose board, commission or governing body you seek to be named?
REFERENCESPlease list the names, addresses and telephone numbers of at least three individuals who would have direct knowledge of your talents, capabilities, and qualifications for this position:
By typing my name and date on the lines below, I have attached my signature electronically to this application
Your application has been submitted.