Boards, Commissions and Committees Application

Citizen Advisory Groups

General Information:
City: State: Zip:
Home Phone:
Work Phone:
Business Address:
City: State: Zip:
Are you a Modesto resident? Yes No
If yes, what was the date of residency?
Are you a registered voter in the City of Modesto? Yes No
Are you a registered voter in Stanislaus County? Yes No
Are you now or have you ever been employed by the City of Modesto?
Yes No
If yes, in what capacity?
Inclusive dates:
Do you have relatives or a member of your household who are employed by the City of Modesto, or who are currently serving on the City Council, or who are Board members or Commissioners?
Yes No
If yes, please explain:
List relevant employment, training, and experience, certificates of training, licenses, and
professional registration.
How did you learn about the board for which you are applying?
Community Group Newspaper Place of Employment Utility Bill Insert  Other:
Describe your involvement in community activities and civic organizations.
(Do not list partisan political parties.)
What is it about this position that interests you?
What qualities, experience, and expertise would you bring to it?