Interim Manager Questionnaire

Please note a review by the Ethics Committee may take up to 60 days.

First Name *

Last Name *

City *

State *

Phone Number *

Cell Phone Number

Membership in MME is required for inclusion on this listing. *

I am a member in good standing with MME.

Membership in ICMA is strongly recommended. *

I am a member in good standing with ICMA.

I am not a member.

Experience as a manager, administrator or assistant of a city, village, township, county, or council of government. *

Yes

What is your interest in interim management assignments? *

Retired, want to stay active in profession.

In transition, looking for a full-time permanent placement.

OtherOther

In what regions would you accept interim assignments? *

Select areas in which you have demonstrated expertise: *

Total years as a public Manager/Administrator: *

Provide three employment references.

First Reference - Full Name, Title, Phone, Email *

Second Reference - Full Name, Title, Phone, Email *

Third Reference - Full Name, Title, Phone, Email *

Submit your resume to be posted with your online listing: (PDF, MS Word files types accepted) *

Maximum upload size: 5MB