HomeMy Public PortalAboutExpression of Interest in City Council Form[image: Logo
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City Council Expression of Interest
Name
Date
Address
Mobile Phone
Work Phone
Occupation
# Years Riverdale Resident
Previously served as an elected official (here or elsewhere)?
☐ Yes ☐ No
Office
Years Served
Previous participation in City committees, commissions, or boards?
☐ Yes ☐ No
If yes, list:
List any 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?
What do you see as the most important issues the City Council is dealing with currently? What additional issues do you think may need to be addressed?
Please list any other personal experiences, background, or attributes that you believe would make you an effective City official:
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 Date
City of Riverdale, Iowa
110 Manor Drive, Riverdale, Iowa 52722 (563) 355-2511 www.riverdaleia.org
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