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
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
6. OCCUPATION AND EDUCATION ← Place a mark in this box if you are retired.
□ ← Place a mark in this box if you are retired.
Place a mark in this box if you are retired
Current Employer
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?
bigsqcupbigsqcup 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