6. I understand the role and responsibility of membership on these Boards or Commissions and am willing to serve. In applying for appointment, I understand that the Mayor may contact the references listed.
Application for Appointment to a City Board, Commission, or Committee Date: Name: First Address: Middle Last Street Employer: Title/Occupation: Address: Street City Phone: State Zip Email: At which address would you prefer to be contacted? Phone: Email: Home City Work State Zip Are you a registered voter of the city of Sioux Falls? Yes No Are you a resident of the city of Sioux Falls? Yes No 1. I would like to serve on the following (please rank if selecting more than one): ADA Accessibility Review Board Accessible Housing Advisory Board Airport Authority Board Arena/Convention/Entertainment Center Board Board of Ethics Board of Health Board of Museum Trustees Board of Historic Preservation Building Board of Appeals Business Improvement District Board--Main Street Charter Revision Commission City Naming Committee Civil Service Board Commission on Human Relations Disability Awareness Commission Electrical Board of Appeals and Examiners Employee's Retirement System Board of Trustees Falls Community Health Center Governing Board Firefighters' Pension Fund Board of Trustees Housing and Redevelopment Commission Infrastructure Review Advisory Board Investment Advisory Board Library Board of Trustees Mechanical Board of Appeals and Examiners Multi-Cultural Center Board Parks and Recreation Board Planning Commission Plumbing Board of Appeals and Examiners Property Maintenance Board of Appeals Public Parking Advisory Board Public Transit Advisory Board School Traffic Safety Advisory Committee (PATH) Experience Sioux Falls Business Improvement District (the BID) Sioux Falls Regional Emergency Medical Services Authority (REMSA) Sioux Falls Sports Authority Solid Waste Planning Board Visual Arts Commission Washington Pavilion Management, Inc. Board of Trustees Zoning Board of Adjustment Zoological Society of Sioux Falls 2. Please list education or training relevant to your choice(s): Please list work experience relevant to your choice(s): I:\AD\001\Y01\Y010005.DOCX 08/20/20 Please list community volunteer service relevant to your choice(s): 3. I would like to serve in the indicated position(s) because: 4. The following references may be contacted: Name: Address: Name: Address: Phone: Phone: 5. Please submit a resume and/or a brief autobiography. 6. I understand the role and responsibility of membership on these Boards or Commissions and am willing to serve. In applying for appointment, I understand that the Mayor may contact the references listed. I also understand that I might be contacted by citizens or other board members at the address I indicated on the other side of this application. Signature Please return application to: Mayor's Office 224 West Ninth Street P.O. Box 7402 Sioux Falls, SD 57117-7402 Your application will be kept on file for three years. Thank you for applying. The City of Sioux Falls does not discriminate on the basis of race, color, religion, sex, sexual orientation, national origin, creed, ancestry, pregnancy, age, genetic information, or disability in the selection of those chosen to serve on a City Board or Committee. I:\AD\001\Y01\Y010005.DOCX 08/20/20mary hublou Adobe PDF Library 19.10.96