Boards, Commissions & Committees Application

2. Boards, Commissions & Committees Application

4. 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)

6. If other, please specify:

8. First Name

9. Last Name

11. Address

13. City

14. State

15. Zip Code

17. Home Phone

18. Work Phone

20. Email Address

21. Occupation

23. Employer / Business

25. Business Address

27. City

28. State

29. Zip Code

31. Education

35. Qualifications:

37. Are you a Modesto resident?

    1. Yes
    2. No

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

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

    1. Yes
    2. No

41. Are you a registered voter in Stanislaus County?

    1. Yes
    2. No

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

    1. Yes
    2. No

44. If yes, in what capacity?

45. Inclusive dates:
    Inclusive dates: Start Date

    —

    Inclusive dates: End Date

47. 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

49. If yes, please explain:

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

53. 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)

55. If other, please specify:

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

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

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

Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field