Form Center

2. Contact Information
4. Name*
6. Address*
8. City*
9. State*
10. Zip Code*
12. Primary Phone Number*
13. Email Address*
15. Preferred Method of Contact*
    -- Select One --Phone callEmailText message
19. About Boards & Commissions
21. Board applying for:*
    -- Select One --Board of Public WorksBrownfield Development Authority/EDCBuilding AuthorityCanvassing BoardCass District Library BoardEconomic Development Corp Board/Brownfield Dev AuthorityHistorical CommissionLand Bank AuthorityParks and Recreation CommissionPlanning CommissionRoad CommissionSolid Waste Planning CommitteeVeterans' Advisory CommitteeVeterans' Trust Fund Board

    Please select the board or commission you are most interested in serving. 

23. Are you interested in serving any other boards or commissions? If so, which?*
25. Referral Source

    1. County Official
    2. Friend
    3. Social Media
    4. County Website

    1. Newspaper
    2. Relative
    3. Government Official
    4. Other
27. If "Other", please specify:
29. Availability*

    Below is the current schedule for boards and commissions. 

    • Board of Public Works — 7:30 p.m. Wednesday following the second Monday of each month
    • Building Authority — at the call of the chair
    • Cass District Library Board — 7 p.m. third Thursday of each month
    • Economic Development Corporation/Brownfield Development Board — 8:30 a.m. fourth Wednesday of each month
    • Historical Commission — 5 p.m. second Thursday of each month
    • Land Bank Authority — at the call of the chair (typically mornings)
    • Parks and Recreation Commission — 4 p.m. second Thursday of each month
    • Planning Commission — 4 p.m. fourth Wednesday of each month
    • Road Commission — 9 a.m. first and third Thursday of each month
    • Solid Waste Planning Commission — at call of the chair

    Are you regularly available during the time the board or committee you wish to join meets?

    1. Yes
    2. No
31. Employment Background*

    Please briefly list any employment experience that would benefit you on the board or commission for which you are applying. 

33. Civic/Volunteer Involvement*

    Please list all volunteer/nonprofit experience that may benefit you in this position.

35. What skills or qualities do you possess that would make you a good fit for this position?*
37. What do you hope to accomplish in this role?*
39. References

    Please list two non-familial references and their contact information.

41. Name*
42. Phone or Email Address*
44. Name*
45. Phone or Email Address*
49. Demographic Information
51. In order to track the effectiveness of our appointments process and ensure we consider the needs of all our county residents, please consider the following optional questions. Cass County Government does not discriminate on the basis of race, color, age, gender identity, or any other basis of discrimination prohibited by law.
53. Are you a resident of Cass County?*

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

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

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

    1. Yes
    2. No
62. If yes, please explain:
64. Age

    1. Under 18
    2. 19-25
    3. 26-35
    4. 36-45

    1. 46-55
    2. 56-65
    3. 66-75
    4. 76+
65. Highest Level of Education

    1. Grade School
    2. High School Diploma
    3. Associate's Degree
    4. Vocational Certificate

    1. Bachelor's Degree
    2. Master's Degree
    3. PhD or Doctoral Degree
67. Electronic Signature Agreement
Leave This Blank:


69. 1. Receive an email copy of this form.
70. Email address

    This field is not part of the form submission.

71. Submit Submit and Print

* indicates a required field