Veterans Affairs Commission Member Application

1. Name*
2. Address*
3. Home Phone
4. Cell Phone*
5. Business Phone
6. Fax
7. Email Address*

Place of employment and position, including service in the armed forces and/or activities such as hobbies, volunteer work, etc. that you feel may qualify you for this position

Employment / Service / Activity 1

1. Employer, Service, and/or Activity
2. Position
3. Contact Number

Employment / Service / Activity 2

4. Employer, Service, and/or Activity
5. Position
6. Contact Number

Employment / Service / Activity 3

7. Employer, Service, and/or Activity
8. Position
9. Contact Number

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10. What military actions did you serve in?
11. DD214 Upload
    For verification, please upload a PDF copy of your DD214, or provide it to the Veterans Affairs Office or Recorder's Office.
12. Letter of Recommendation Upload
    A letter of recommendation is required for those who are currently serving in the Iowa National Guard or an Iowa unit of the reserve forces. Former members of the Iowa National Guard or an Iowa unit of the reserve forces can submit a DD214 or a letter of recommendation from the commander of the person's last unit.
13. How much time will you be willing to devote to this position?

1. Interest in Appointment: Describe in detail why you are interested in serving on this commission. Include information about your background that supports your interest.
2. Contributions you feel you can make to the commission
3. Direction or role you see for this commission
4. In addition to the above, do you have any other comments that may assist the Board of Supervisors in its selection?

Please provide two references who can confirm your qualification for this position.

Reference 1

1. Name*
2. Phone Number*
3. Address
4. Email Address
5. Relationship*

Reference 2

6. Name*
7. Phone Number*
8. Address
9. Email Address
10. Relationship*

I certify that there is nothing that would prohibit me from serving on this board or commission and I certify that I will abstain from voting on any issue in which I have a vested interest or that personally affects me.

1. Signature* Please type your full name to serve as an electronic signature.
2. Date*
3. reCAPTCHA