Applicant Last Name
First Name
Mr. / Mrs. / Ms.

Last Name First Name Mr./Mrs./Ms.

Name of Board, Committee, Commission

Name of Board, Committee, or Commission to which you are applying

  1. 5. Briefly explain why you would you like to be appointed to this committee and what 3 primary areas of concern do you feel should be addressed by this committee? Rank with the most critical at the beginning of the list.

Why?

Why do you want this appointment?

a. ___

1st area of concern

b. ___

2nd area of concern

C. ___

3rd area of concern
  1. 6. OCCUPATION AND EDUCATION ← Place a mark in this box if you are retired.

[Unabel] ← Place a mark in this box if you are retired.

Place a mark in this box if you are retired
Current Employer

Job Title Length of Employment

Job Title
Length of Employment?

Previous Employers Position/Job Title Name of City/County Length of Employment

Previous Employers [1]
Position/Job Title [1]
City/County [1]
Employment [1]
Previous Employers [2]
Position/Job Title [2]
City/County [2]
Employment [2]
Previous Employers [3]
Position/Job Title [3]
City/County [3]
Employment [3]

Names of College/University Course of Study/Major Degree Type Awarded

Previous Employers [4]
Position/Job Title [4]
City/County [4]
Employment [4]
Names of College/University [1]
Course of Study/Major [1]
Degree Type Awarded [1]
Names of College/University [2]
Course of Study/Major [2]
Degree Type Awarded [2]
Names of College/University [3]
Course of Study/Major [3]
Degree Type Awarded [3]
Names of College/University [4]
Course of Study/Major [4]
Degree Type Awarded [4]
  • 7. How long have you been a resident of Madera County?

bigsqcup Months bigsqcup Years bigsqcup Lifetime Resident

Months
Years
Lifetime Resident?
Not a resident of Madera County

Lifetime Resident

54,5M

Years

Not a resident

BOARD OF SUPERVISORS 200 West 4th Street · Madera, CA 93637 · 559.675.7700 · madco311.com · maderacounty.com