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2. Name
3. Date
5. Address
7. City
8. State
9. Zip Code
11. Home Phone Number
12. Work Phone Number
14. Email Address
16. Referral Source

    1. County Official
    2. Friend
    3. Newspaper
    4. Relative
    5. Township Official
    6. Other
17. If "Other", please specify:
19. Are you a resident of Cass County?

    1. Yes
    2. No
21. Are you a citizen of the United States?

    1. Yes
    2. No
23. Are you related to any Cass County employee?

    1. Yes
    2. No
24. If yes, who are you related to?
26. Have you ever been convicted of a felony?

    1. Yes
    2. No
27. If yes, please explain:
29. Throughout the year opportunities to server open up in the following groups. Please check all Board and Commissions you are interested in serving on:

    1. Agriculture
    2. Construction
    3. Finance
    4. History
    5. Industry/Commerce
    6. Infrastructure Water/Sewer/Roads

    1. Mental Health
    2. Planning/Zoning/Land Use
    3. Public Health and Welfare
    4. Recycling/Environment
    5. Tourism/Recreation
    6. Veterans Affairs
31. Please tell us why you are interested in being appointed to a board or commission:
33. What personal qualities do you have that will contribute to service on a board or commission?
35. What are your particular skills or experience (i.e., financial, management, community service, leadership)?
37. Additional Comments
39. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or disability.
41. Electronic Signature Agreement
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43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

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