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Appointment Application

  1. In selecting members for the various boards and commissions in St. Charles County, the County Executive seeks to identify individuals with a conscientious commitment to the betterment of the community and a reputation of fairness and integrity.

  2. Are you a registered voter?

  3. Do you live within the boundaries of a municipality?

  4. Board or Appointment Desired

  5. Post-secondary

  6. Have you previously served on a board or commission?

  7. Do you currently serve on any boards or commissions?

  8. Have you ever held an elected or appointed office?

  9. (Addendum to Application for Appointment to County Boards and/or Commissions)

  10. 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?

  11. If your answer is yes, please identify the person or persons, by whom they are employed, and the nature of your relationship.

  12. 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?

  13. If your answer is yes, please identify such enterprise and describe your relationship with it.

  14. 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?

  15. If your answer is yes, please identify such enterprise and describe your relationship with it.

  16. 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?

  17. If your answer is yes, please identify such enterprise and describe your relationship with it.

  18. 5. Are you current on real estate and personal property taxes payable to St. Charles County?

  19. Please list the names, addresses, and telephone numbers of at least 3 individuals who would have direct knowledge of your talents, capabilities, and qualifications for this position.

  20. By typing my name and date on the lines below, I have attached my signature electronically to this application

  21. Leave This Blank:

  22. This field is not part of the form submission.