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Boards, Commissions & Committees Application

2. Boards, Commissions & Committees Application

4. Title II Compliance
   In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the <a href="https://www.modestogov.com/865/Americans-with-Disabilities-Act-ADA">City of Modesto website</a>.

   In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the City of Modesto website.

6. Apply To:

   1. Airport Advisory Committee
   2. Board of Building Appeals
   3. Board of Zoning Adjustment
   4. Citizens Housing & Community Development Committee
   5. Citizens' Transportation Sales Tax Commission
   6. Culture Commission
   7. Disabled Access Appeals Board
   8. Entertainment Commission

   1. Equal Opportunity / Disability Commission
   2. Golf Courses Advisory Committee
   3. Housing Rehabilitation Loan Committee
   4. Human Relations Commission
   5. Landmark Preservation Commission
   6. Planning Commission
   7. Tuolumne River Regional Park Citizens Advisory Committee
   8. Other (Please Specify)

8. If other, please specify:

10. First Name

11. Last Name

13. Address

15. City

16. State

17. Zip Code

19. Home Phone

20. Work Phone

22. Email Address

23. Occupation

25. Employer / Business

27. Business Address

29. City

30. State

31. Zip Code

33. Education

37. Qualifications:

39. Are you a Modesto resident?

    1. Yes
    2. No

40. If yes, what was the date of residency?
    If yes, what was the date of residency?

42. Are you a registered voter in the City of Modesto?

    1. Yes
    2. No

43. Are you a registered voter in Stanislaus County?

    1. Yes
    2. No

45. Are you now or have you ever been employed by the City of Modesto?

    1. Yes
    2. No

46. If yes, in what capacity?

47. Inclusive dates:
    Inclusive dates: Start Date

    —

    Inclusive dates: End Date

49. Do you have relatives or a member of your household who are employed by the City of Modesto, or who are currently serving on the City Council, or who are Board members or Commissioners?

    1. Yes
    2. No

51. If yes, please explain:

53. List relevant employment, training, and experience, certificates of training, licenses, and professional registration.

55. How did you learn about the board for which you are applying?

    1. Community Group
    2. Newspaper
    3. Place of Employment
    4. Utility Bill Insert
    5. Other (Please specify)

57. If other, please specify:

59. Describe your involvement in community activities and civic organizations. (Do not list partisan political parties.)

61. What is it about this position that interests you?

63. What qualities, experience, and expertise would you bring to it?

Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit

* indicates a required field