Thank you for your interest in public service for the City of Olathe.

1

Tell us about yourself. (View the Ward Map to help determine which Ward you live in.)

 *

Tell us about yourself. (View the Ward Map to help determine which Ward you live in.)

First Name	Last Name
Phoneext.	Home Address
City (Home Address)	State (Home Address)(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip (Home Address)	Ward
Email	Work Address
City (Work Address)	State (Work Address)(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip (Work Address)

2

Are you a registered voter?

 *

Are you a registered voter?

Yes

No

3

What Committee, Board, Commission or Task Force would you like to serve on? Please read the full description of the board for which you are applying.

What Committee, Board, Commission or Task Force would you like to serve on? Please read the full description of the board for which you are applying.

Board of Code Review	Board of Housing Commissioners
Citizens Police Advisory Council	Historic Preservation Board
Human Relations Commission	Mahaffie Foundation Board
Parks and Recreation Foundation Board	Persons with Disabilities Advisory Board
Planning Commission	Public Art Committee
Street Maintenance Sales Tax Committee	Other If other, type text here.

4

What date did you attend a meeting of the committee or board you are a applying to serve on?

What date did you attend a meeting of the committee or board you are a applying to serve on?

5

Why do you wish to serve on this board?

Why do you wish to serve on this board?

6

Have you previously served on other City of Olathe boards or committees?

 *

Have you previously served on other City of Olathe boards or committees?

Yes (if yes, please tell us where you have served) If other, type text here.

No

7

Tell us about your employment.

Tell us about your employment.

Where do you work?	What is your position?
What product or service is rendered by your employer?	What are your job duties and responsibilities?

8

Describe any work or volunteer experience that is related to the function of this board or committee.

Describe any work or volunteer experience that is related to the function of this board or committee.

9

Please list degree(s), certificate(s) or additional education that may be related to the function of this board or committee.

Please list degree(s), certificate(s) or additional education that may be related to the function of this board or committee.

10

Please list any community organizations you belong to and discuss your level of involvement.

 *

Please list any community organizations you belong to and discuss your level of involvement.

11

Please attach your resume/CV.

Please attach your resume/CV. Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

12

Do you have any conflict of interest in serving on this board or committee?

Do you have any conflict of interest in serving on this board or committee?

Yes (If yes, please explain) If other, type text here.

No

13

Are you related to a member of the City Council or a City staff member? If so, please list their name and position.

Are you related to a member of the City Council or a City staff member? If so, please list their name and position.

Yes

No

If "Yes" please list name and job title of relative

14

Do you, or have you ever, worked for the City of Olathe?

Do you, or have you ever, worked for the City of Olathe?

Yes

No

15

Please read the City of Olathe Code of Ethics and the Boards, Commissions and Committees policy and check the box to confirm you've read both items.

I certify that I have read both items.

16

Other information or comments:

Other information or comments:

17

How did you learn about this public service opportunity?

How did you learn about this public service opportunity?

Website

Social Media

Public Meeting

Word of Mouth

18

If someone recommended you apply, please list that person's name.

Name

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

Page 1 / 1