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2. Application for Voluntary Boards and Committees
   The Board of Kootenai County Commissioners wishes to guarantee that their appointments to Kootenai County committees, commissions, and boards will best serve the public interest of the County as well as be representative of a broad cross-section of the community. We ask you to provide us with the information that will best assist us in evaluating your application. While we appreciate all applicants’ interest and willingness to volunteer, due to potential conflicts of interest, Kootenai County employees are not permitted to serve on any volunteer board that is overseen by the Kootenai County Commissioners.
4. Applying for*
   -- Select One --Airport Advisory BoardAquifer Protection BoardAgricultural Protection Area CommissionBoard of Community Guardians Fair BoardHistoric Preservation CommissionNatural Resource Advisory BoardNoxious Weeds Advisory BoardParks & Waterways Advisory BoardPlanning & Zoning CommissionSnowmobile Advisory Board

   A separate application should be submitted for each board you are applying to

6. I. PERSONAL INFORMATION
8. First Name*
9. Last Name*
11. Street Address*
13. Address Line 2 or Mailing Address
15. City*
16. State*
17. Zip*
19. Home Phone*
20. Work Phone
22. Email Address*
24. Place of Employment*
25. How long at current job?
27. How long have you been a resident of Idaho?*
28. How long have you been a resident of Kootenai County?*
30. II. EDUCATION
32. Do you have a high school diploma or high school equivalency (i.e. GED)?*

    1. Yes
    2. No
33. If yes, where did you attend?
35. Do you have an undergraduate degree from a college or university?*

    1. Yes
    2. No
36. If yes, where did you attend?
38. Do you have a graduate degree from a college or university?*

    1. Yes
    2. No
39. If yes, where did you attend?
41. Do you have any other specialized training or certifications?*

    1. Yes
    2. No
42. If yes, where did you attend?
44. III. Experience
46. Have you previously applied for a volunteer committee, commission or board for any city or county agency?*

    1. Yes
    2. No
47. If so, which one(s)?
49. Have you previously served or are you currently serving on a volunteer committee, commission or board for any city or county agency?*

    1. Yes
    2. No
50. If so, which one(s)?
52. Have you ever attended a meeting of the volunteer committee, commission or board for which you are applying?*

    1. Yes
    2. No
54. Please briefly describe your understanding of the responsibilities of the volunteer committee, commission, or board for which you are applying:*
56. What particular talents or skills would you bring to the volunteer committee, commission or board for which you are applying?*
58. Please describe your involvement in, or affiliation with, any professional associations:*
60. IV. CONFLICTS OF INTEREST
62. Have you ever been involved in litigation against Kootenai County or any of its agencies?*

    1. Yes
    2. No

    Answering 'yes' is not a disqualification from consideration of an advisory board appointment.
64. Please explain any conflicts of interest or potential conflicts of interest not already set forth above that you may have if chosen for an appointment to the volunteer committee, commission or board for which you are applying:*
    If you are unsure what constitutes a conflict of interest, please contact the Commissioners' office at (208) 446-1600.
66. V. MISCELLANEOUS
68. Meetings can be held in morning hours, noon hours, afternoon hours and evening hours. There can be a meeting once a week or more. Are you able to attend meetings during these hours?*
    Please note that the Planning & Zoning Commission usually has at least one regular meeting per month; however, workshops and special meetings can be as frequent as once a week.
70. Why do you wish to be a member of the volunteer committee, commission or board for which you are applying?*
72. Kootenai County is committed to the implementation of the Americans with Disabilities Act. Are you familiar with this law?*

    1. Yes
    2. No
74. I certify the answers I have made to each and all of the foregoing questions are true to the best of my knowledge and belief. By signing below, I acknowledge that I understand Kootenai County may independently verify any information submitted within this application.
76. Electronic Signature Agreement*

    By checking "I agree" (below), you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I Agree
    2. I Do Not Agree
78. Signature*
79. Date*
    Date
81. Please note that all application materials submitted will become public record once submitted and may be disclosed under the Idaho Public Records Law, per Idaho Code §74-101(1), §74-101(12), and §74- 106(1). Kootenai County does not discriminate against individuals or groups on the basis of disability in the admission access to, or treatment in, its public meetings, programs, or activities. Requests for assistance or accommodations can be arranged by contacting the Board of County Commissioners Office at (208) 446-1600.
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83. 1. Receive an email copy of this form.
84. Email address

    This field is not part of the form submission.

85. Submit

* indicates a required field