Form 51-123 - Application For Examination For Position Of City Or County Assessor/city Or County Deputy Assessor
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1
2IOWA DEPARTMENT OF REVENUE
Hoover State Office Building
Des Moines, Iowa 50319
(To be prepared in ink or on typewriter)
CITY OR COUNTY ASSESSOR
APPLICATION FOR EXAMINATION FOR POSITION OF
CITY OR COUNTY DEPUTY ASSESSOR
When completed, this application is to be returned to the Administrator, Property Tax Division, Iowa Department of
Revenue, PO Box 10469, Des Moines, Iowa 50306-0469. Application must be received by the Department of Revenue
at least 3 days prior to the date of the examination. It is the responsibility of each applicant to see to it that the
application is timely received by the Department.
A. PERSONAL DATA
________________________________
_________________________________
Telephone No.
E-mail Address
1. ________________________________________________________________________________________________________
(First Name)
(Middle)
(Last)
2. ________________________________________________________________________________________________________
Street Number or PO Box
City
State
Zip Code
B. EDUCATIONAL DATA
3. HIGH SCHOOL
Last grade completed: _________________ Name of school: ____________________________________________
Location: ____________________________ Did you graduate from high school?
Yes
No
If yes, year graduated: _________________ Dates of attendance: From: ____________ To: __________
If you plan to graduate prior to the date of the examination, please indicate anticipated date: ________________
High school equivalency certificate (G.E.D.)?
Yes
No If yes, give date certificate issued: ____________
Certificate issued by: _________________________________
4. VOCATIONAL TRAINING (BUSINESS, TRADES, TECHNICAL, MILITARY SERVICE)
From
To
Number of
Credits
Date of Diploma
Subject or
Hours Attended
Earned
or Certificate
Course Title
Name and Location
Mo
Yr
Mo
Yr
per Week
Name
Location
Name
Location
Name
Location
5. UNIVERSITY AND COLLEGE (UNDERGRADUATE, GRADUATE, DOCTORATE)
Date of Graduation
From
From
Total
Total
No.
degree award
Sem.
Qtr.
of
Name and Location
Mo
Yr
Mo
Yr
hrs
hrs
Fields of Study
hrs
Mo
Yr
Degree
Name
Major
Location
Minor
Mo
Yr
Degree
Name
Major
Location
Minor
Mo
Yr
Degree
Name
Major
Location
Minor
NOTE: COMPLETE REVERSE SIDE
51-123a (06/09/10)
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