2. Boards of Interest (Choose 3)*

   1. Aging & Disability Resource Board
   2. Board of Adjustment
   3. County Board Vacancy
   4. County Traffic Safety Commission
   5. Monarch Library System Board
   6. Health & Human Services Board

   1. Vocal Emergency Planning Committee
   2. Veterans Service Commission
   3. Land Preservation Board
   4. Library Board
   5. W-O-W Consortium W-2 Community Steering Committee
   6. W-O-W Workforce Development
4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip*
13. Phone*
14. Email*
18. Background Information
20. Why would you like to be appointed to the committee or board you are applying for?
22. What related experience / education / interests do you have that would be beneficial for the board or committee that you would like to serve on?
24. List the community or other activities which you have participated in.
26. Job Information
28. Occupation*
29. Current Employer*
31. Additional Information
33. File Upload
    Use this areas to upload additional files or information
37. VOLUNTARY AFFIRMATIVE ACTION / EQUAL EMPLOYMENT OPPORTUNITY DATA
    The following information will be used only for research and reporting purposes for Ozaukee County and the Federal Government in accordance with applicable laws and regulations. This information is voluntary and there will be no adverse consequences for not responding. This information is confidential and is kept separate from this application. It will not be a consideration for application purposes.
39. Sex:

    1. Male
    2. Female
40. Birth date:
42. Ethnic Origin:

    1. American Indian/Alaskan Native
    2. Black/African American (Not of Hispanic origin)
    3. White/Caucasian/European/North African/Middle Eastern or Indian Subcontinent
    4. Hispanic/Chicano/Puerto Rican/Mexican/Cuban/Central or South American
    5. Asian American/Pacific Islander/Far Eastern or Southeastern Asian
44. Veteran Status:

    1. Non Veteran
    2. Veteran
    3. Disabled Veteran (Disability less than 30%)
    4. Special Disabled Veteran (Disability 30% or greater)
46. Disability

    The Americans with Disabilities Act (ADA) defines an individual with a disability as “one who has a physical or mental impairment that substantially limits one or more major life activities, has a record of such an impairment, or who is regarded as having such an impairment.” Based on this definition, are you an individual with a disability?

    1. Yes
    2. No
48. Ozaukee County is committed to the equality of opportunity for all people. It is the policy of Ozaukee County to provide equal employment and appointment opportunities for all individuals, on the basis of their skills, abilities and qualifications, without regard to race, color, national origin, religion, political affiliation, sex, age, disability, marital status, arrest or conviction record, sexual orientation, disabled veteran or covered veteran status, membership in the National Guard or any other reserve component of the United States or State military forces, use or nonuse of lawful products off the employer’s premises during non-working hours, or any other nonmerit factors, except where such factors constitute a bona fide occupational qualification.
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field