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Application for Appointment to Board, Commission, Committee, Task Force or Position

  1. Applicants appointed by the Board of Supervisors will be required to take an oath of office. All applications will be kept on file for one year from the date of application.

  2. Public Records Act

    Applications are public records that are subject to disclosure under the California Public Records Act. Information provided by the applicant is not regarded as confidential except for the addresses and phone numbers of references and the applicant's personal information including home and work addresses, phone numbers and email address.

  3. Name of Board, Commission, Committee, Task Force or Position.

  4. This information can be found on the news release announcing the opening. You may apply for more than one category if more than one position is open.

  5. Personal Information

    The following information is provided in confidence, but may be used by the Board of Supervisors when making the appointment, or be used by the Committee/Commission/Board/Task Force following appointment for purposes of communicating with the appointee.

  6. Within the last 12 months

  7. Professional or occupational, date of issue, and expiration including status

  8. Attach a resume containing this and any other information that would be helpful to the Board in evaluating your application.

  9. Nature of activity and community location

  10. List all court or other public administration actions impacting your credit rating within the past ten (10) years.

  11. Provide names, addresses and phone numbers of 3 individuals who are familiar with your background.

  12. Reference 1

  13. Reference 2

  14. Reference 3

  15. For Conflict of Interest purposes

  16. I declare under penalty of perjury that the foregoing is true and correct.*

  17. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  18. Leave This Blank:

  19. This field is not part of the form submission.