2. Application for Appointment to a City Board, Commission or Committee
4. First Name
5. Last Name
6. Phone
8. Email
10. Address1
11. Address2
13. City
14. State
15. Zip
19. Employer:
20. Title / Occupation:
21. Phone
23. Address1
24. Address2
26. City
27. State
28. Zip
32. At which address would you prefer to be contacted?

    1. Home

    1. Work
33. Are you a resident of the City of Pierre?

    1. Yes

    1. No
35. I would like to serve on the following:

    1. Arbor Board
    2. Board of Adjustment
    3. Golf Board
    4. Historic Preservation
    5. Housing & Redevelopment

    1. Library Board
    2. Parks & Recreation
    3. Planning Commission
    4. Traffic Safety Committee
    5. Other
37. Please list education or training relevant to your choice(s):
39. Please list work experiences relevant to your choice(s):
41. Please list community volunteer service relevant to your choice(s):
43. I would like to serve in the indicated position(s) because:
45. The following references may be contacted:
47. First Name
48. First Name
50. Last Name
51. Last Name
53. Address1
54. Address1
56. Address2
57. Address2
59. City
60. City
62. State
63. Zip
64. State
65. Zip
67. Phone
68. Phone
70. Please submit a resume and/or brief autobiography.
72. I understand the role and responsibility of membership on these Boards or Commissions and am willing to serve. I am willing to attend scheduled meetings unless I have a conflict. In applying for appointment, I understand 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 this application.

    1. Agree

    1. Disagree
74. Thank you for your interest and willingness to serve!
Leave This Blank:


76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit Submit and Print

* indicates a required field