c7b3ccac-7e09-4e22-ac18-9f6c5326da13_Application_for_Appointment-artifacted.pdf — PaddleOCR-VL (Baidu)

APPLICATION FOR APPOINTMENT TO COUNTY OF MADERa BOARDS, COMMISSIONS OR COMMITTEES

Mr. / Mrs. / Ms.

L act Namo

Applicant Last Name

Last Name First Name

。

First Name

Mr. / Mrs. / Ms.

Name of Board, Committee, Commission

Supervisorial District?

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

What or whose

Supervisorial 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: ___

Check here if you can schedule time accordingly

Check here if you CANNOT schedule time accordingly

List any time restrictions

Additonal 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

Committee/Organization’s Name [1]

Date Appointed [1]

Committee/Organization’s Name [2]

Date Appointed [2]

Committee/Organization’s Name [3]

Date Appointed [3]

Committee/Organization’s Name [4]

Date Appointed [4]

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

Committee/Organization’s Name [1]

Dates Served [1]

Committee/Organization’s Name [2]

Dates Served [2]

Committee/Organization’s Name [3]

Dates Served [3]

Committee/Organization’s Name [4]

Dates Served [4]

4. Provide any other experience, special knowledge or principal areas of interest in County Government that would be helpful in making this appointment.

Experience, Special Knowledge