County Board - Jack D. Franks, County Board Chairman
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County of McHenry Appointed Member of Board, Commission, or Elected Office Vacancy Application

Please correct the field(s) marked in red below:

 Elected position or board/commission applying for:
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How did you become aware of this available position?

Applicant Information

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Applicant Information
Have you worked for McHenry County before?
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Have you worked for McHenry County before?
If yes, give date(s):
Do you have any relatives currently employed by McHenry County or any political sub-division thereof?
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Do you have any relatives currently employed by McHenry County or any political sub-division thereof?
If yes, please provide name(s):
Have you ever been convicted of or charged with a felony or misdemeanor? (A conviction will not automatically disqualify you from an appointment; exclude minor traffic violations.)
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Have you ever been convicted of or charged with a felony or misdemeanor? (A conviction will not automatically disqualify you from an appointment; exclude minor traffic violations.)
If yes, please explain:
Are there any felony/misdemeanor charges pending against you?
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Are there any felony/misdemeanor charges pending against you?
If yes, please explain:

Employment History

Your work experience is an important factor in evaluating your qualifications. Please list your current employer.

Employment History Your work experience is an important factor in evaluating your qualifications. Please list your current employer.
May we contact this employer?
May we contact this employer?
Dates of Employment:
Dates of Employment:
Job title & description of duties performed:

Public/Civic Leadership Information

What do you believe is the role of the elected office or board/commission for which you are applying?

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Do you or any of your close family or business connections make use of services provided by, or connected with, the elected office or board/commission for which you are applying?
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Do you or any of your close family or business connections make use of services provided by, or connected with, the elected office or board/commission for which you are applying?
If yes, please explain:
Do you or any of your close family or business connections serve in any elected office, on any board/commission, or with any organization which has or may have any connection or relationship with the elected office or board/commission for which you are applying?
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Do you or any of your close family or business connections serve in any elected office, on any board/commission, or with any organization which has or may have any connection or relationship with the elected office or board/commission for which you are applying?
If yes, please explain:

References

Please give the names of three persons, not related to you, whom you have known for over one year.

Reference 1
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Reference 1
Reference 2
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Reference 2
Reference 3
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Reference 3

Education & Life Experience

Are you currently or have you previously served as an elected official, served in a government commission, or private organization?

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Education & Life Experience Are you currently or have you previously served as an elected official, served in a government commission, or private organization?
If yes, please explain:
What education, training, or experience do you believe would assist you with serving the elected office or board/commission for which you are applying?
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What do you hope to accomplish as a result of serving the elected office or board/commission for which you are applying?
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Certification & Release - Read Carefully

I certify that the answers and information given by me in this application are true, correct and complete without qualification. I understand the County has the right to refuse to appoint me or immediately discharge me, at any time if it discovers I have provided incomplete, untrue, or misleading answers or information in this application or on any other documents or forms submitted at any time during my employment.

I authorize the County and its agents, to verify the answers and information given by me in this application and to make any investigation of my background deemed necessary. I authorize former employers, law enforcement organizations, educational institutions, and any other third party contacted by the County or its representatives, to release to the County or its agents information which may be used to verify information in this application.

I understand that any position I am appointed to may require me to complete a Statement of Economic Interest and the McHenry County Addendum to the Statement of Economic Interest to be filed with the McHenry County Clerk.

 
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