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APPLICATION FOR APPOINTMENT TO COUNTY OF MADERa BOARDS, COMMISSIONS OR COMMITTEES
I get Now
Last Name First Name
Mr. / Mrs. / Ms.
Name of Board, Committee, or Commission to which you are applying What or whose
What or whose
Supervisor District do you reside in?
- 1. Majority of County Boards, Commissions and Committees meet during the day, however some meet in the evening. Additionally, some meet weekly, bi-weekly, or monthly. Will you be able to schedule your time accordingly?
Yes ___ No ___ List any time restrictions: ___
- 2. List all boards, commissions, committees, clubs and/or community or public organizations of which you are currently a member. (Attach a separate sheet if necessary) Committee/Organization's Name Date Appointed
- 3. List any past appointments to boards, commissions committees, clubs and/or community or public organizations to which you served. (Attach a separate sheet if necessary) Committee/Organization's Name Dates Served
- 4. Provide any other experience, special knowledge or principal areas of interest in County Government that would be helpful in making this appointment.
Last Name First Name Mr./Mrs./Ms.
Name of Board, Committee, or Commission to which you are applying
- 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?
a. ___
b. ___
C. ___
- 6. OCCUPATION AND EDUCATION ← Place a mark in this box if you are retired.
□ ← Place a mark in this box if you are retired.
Job Title Length of Employment
Previous Employers Position/Job Title Name of City/County Length of Employment
Names of College/University Course of Study/Major Degree Type Awarded
- 7. How long have you been a resident of Madera County?
bigsqcupbigsqcup Months bigsqcup Years bigsqcup Lifetime Resident
Lifetime Resident
54,5M
Years
Not a resident
Last Name
First Name
Mr. / Mrs. / Ms.
Name of Board, Committee, or Commission to which you are applying
- Do you or any members of your immediate family work for the County of Madera or hold a position that might conflict with your duties with this appointment? If yes, please explain below.
- CONTACT INFORMATION - Personal information may be withheld from public view as allowed by law.
City State Zip
Home Address
Mailing Address (if different from home address)
Mobile Phone # ☐☐ Home Phone # ☐☐
Business Phone #
Fax #
*Please note which number above is your primary by marking the first radio button or secondary by marking the second radio button.
E-mail Address
Secondary E-mail Address