City Council Vacancy Application

Complete online or print and fill out by hand.

City Council Vacancy Application

Applicant Information

Name

Date

Address

Telephone Number(s)

Occupation

Years Resided in Lenox

Prior Service

Have you previously served as an elected official, here or elsewhere?

Yes No

Office and Years Served

Have you previously participated in any City committees or boards? If so, please list:

Community Involvement

Please list other community activity involvement in the past five years, especially any participation in committee decision-making:

What makes you interested in serving on City Council?

If appointed, what would be some of your goals and objectives going forward?

Applicant's Statement

I certify that I am legally eligible for appointment to the office for which I am applying, including residency requirements. I agree, if appointed, to fairly and impartially, to the best of my ability, discharge all the duties of the office as required by law.

Signature If printing to sign by hand, you may leave this field blank.

Date

Completed applications can be mailed to Lenox City Hall at 200 South Main Street, Lenox, Iowa 50851, or emailed to dawnebowman@lenoxia.com.

This form is not submitted online. Please print and mail, or email a completed copy to City Hall using the address above.