APPLICATION FOR APPOINTMENT TO A COUNTY ADVISORY BODY 

Commission, Committee, or Board:

If applicable, please indicate the category of
representation for which you are seeking
appointment (see above).
Name:
Street:
City:
State:
Zip Code:
Email Address:
Phone (Home):
Phone (Business):
Supervisorial District: 1      2      3      4      5 
Length of Residence in Area
Age (optional): Under 21  21-30  31-40  Over 40

PREVIOUS COMMISSION OR COMMITTEE SERVICE (Please Specify):

Advisory Body

Term

EDUCATION:

Institution Major Degree Year

WORK/VOLUNTEER EXPERIENCE

Organization Address Position Years

STATEMENT OF QUALIFICATIONS:

Please complete a brief statement indicating why you are interested in serving on the advisory body in question and why you are qualified for the appointment:

 

CERTIFICATION:

By checking this box and entering the date, I certify that the above information is true and correct and authorize the verification of the information in the application in the event I am a finalist for the appointment.
         Date: