Regional Workforce Investment Board AppointmentRWIB Application Page 1 of 1
Kevin Firnstahl -RWIB Application
From: "Mihm-Herold, Wendy [IWD]" <Wendy.Mihm-Herold@iwd.iowa.gov>
To: <j schneid@cityofdubuque.org>
Date: 6/9/2008 5:23 PM
Subject: RWIB Application
CC: "Mike Van Milligen" <Mvanmill~acityofdubuque.org>
Attachments: RWIB Appointment Resume Form New.doc
Hello,
We are the process of replacing Ann M. on our RWIB,...she was given approval to stay on until her
term was up June 30th....I need to have two individuals from the City fill out this application and get to
me so I can send into the Governor ASAP...the Govern will go through the applications and determine
if we can vote on one of the members for appointment...than we send our recommendation to the
Governor and he appoints...I hope that makes sense...we went through this process twice before, I also
spoke with Mayor Roy Boul about this....The RWIB has over sight on employment and training issues
to do with the One Stop System in Region One and Dubuque...We meet quarterly in Elkader, we pay
for mileage and they are number of members you can ride with as we11....Please call me if you have any
questions...>Wendy
«RWIB Appointment Resume Form New.doc»
Wendy Mihm-Herold, MS
Regional Manager, Iowa Workforce Development/NICC
1111 Paine Street, Decorah Iowa 52101
(W) 563-382-0457 ext.111 (C) 563-380-3733
Wendy. mihm-heroldCa~iwd.iowa.gov
An Equal Opportunity Employer/Program
Auxiliary aids and services are available upon request for individuals with disabilities.
file://C:\Documents and Settings\kfirnsta\Local Settings\Temp\XPgrpwise\484E2C99DBQ... 6/10/2008
Appointment Resume for Regional Workforce Investment Board
PLEASE TYPE OR PRINT CLEARLY. USE ADDITIONAL SHEETS AS NECESSARY.
Entire form must be completed for consideration by the Governor's Office. Additional information on Regional Boards and the
appointment process are available in the Iowa Administrative Code (877 IAC 6.1-11).
PERSONAL DATA
First Name MI Last Name Mr/Mrs/Miss/other
Leal Residence
City State Zip County
Home Phone Email Address
Employer or Business Name
Address
City State Zip County
Occupation
Business Phone Fax Cell Phone
To assist us in providing balance and to meet our goal of increased diversity within the membership of boards and commissions, we
appreciate your response to these questions. Under state and federal law, this information may not be used to discriminate against you.
Of what race or ethnicity do you consider yourself to be?
^ B lack/African-American ^ White/Caucasian ^ Latino/Hispano
^Asian or Pacific Islander ^American Indian or Alaska Native ^Other
please specify
Birthdate:_ /_/_ ^Female ^Male Are you a citizen of the United States? ^Yes ^No
Are you registered to vote in Iowa? Indicate political affiliation: Democrat Republican No Party
SSN #
EDUCATION List schools attended, include high school. A current resume may be substituted for this section.
School City & State of Iowa Dates Degree/Major
Elected Offices, State Appointed Positions or Membership on Workforce Related Boards or Councils:
Signature Date: / /
(OVER)
Last updated 6/10/2008
EMPLOYMENT & EXPERIENCE List major paid employment & significant volunteer activities. List chronologically
beginning with most recent experience. A Current resume may be submitted for this section.
Dates (from-to) Employer/Organization
City & State Title/Position
INTEREST IN APPOINTMENT Describe in detail why you are interested in serving on a Regional Workforce Investment
Board. Include information about your background that supports your interest. You may complete this section on a separate
sheet.
Signature Date: / /
********************************To be filled out by person referring candidate***************************************
Referred by: (print name) Signature
Organization•
Title:
Reason for nomination (what specific qualities does this person possess which would make them a good
member of the Regional Workforce Investment Board):
***********************To be filled out by Chief Elected Officials of the Region**********************
Please indicate what sector(s) the nominee represents:
Business Labor
School District _ City Official
_ College _ Other
Additional information to be considered by the Governor:
Signature of CEO Chair or designee
_ County Elected Official
Community College
Last updated 6/10/2008
Print name: