Executive
About County Executive Ehlmann
Welcome
Press Releases
Biography
Reports & Information
Annual Report
State of The County Address
Boards & Commissions
Listing
Application
Community Assistance
Complete Count Commission
Contact Information
Contact Us
Welcome arrow Application
Application

APPLICATION FOR APPOINTMENT TO A ST. CHARLES COUNTY
BOARD OR COMMISSION

In 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.
 
Name:
First  Last 
 
Address:
Street  City  State  Zip Code 
 
Home Phone  Work Phone  Cell Phone 
 
Email address   Are you a registered voter? Yes No
Council District Number:Length of residence in St. Charles County 
Do you live within the boundaries of a municipality?  Yes No
 
If so, which municipality?
 Board or appointment desired: (hold ctrl key to select multiples)
 
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? Yes No
If yes, specify: 
 
Do you currently serve on any boards or commissions? Yes No
If yes, specify: 
 
Have you ever held elected or appointed office? 
If yes, specify: 
 
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?
 
DISCLOSURE 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? Yes No
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 St. Charles County Government with any property, goods or services? Yes No
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 St. Charles County Government with any property, goods or services? Yes No
If your answer is yes, please identify such enterprise and describe your relationship with it.
 
4. In the past 12 months, have you participated in or assisted in any transaction between St. Charles County Government and any business enterprise? Yes No
If your answer is yes, please identify such enterprise and describe your relationship with it.
 
REFERENCES
Please 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, between the two forward slashes, I have attached my signature electronically to this application.
/ /
  Enter name above
September 2, 2010
© 2010 St Charles County Government - (636) 949-7900 Executive