__________________________________
NAME
|
|
__________________________________
NAME OF COMMITTEE
|
SUPERVISORIAL
DISTRICT____________
(IF UNKNOWN, CONTACT THE REGISTRAR'S OFFICE AT 468-2890) |
|
__________________________________
RESIDENCE ADDRESS
|
__________________________________
BUSINESS ADDRESS
|
HOME PHONE______________________
BUSINESS PHONE___________________
|
|
__________________________________
OCCUPATION |
| |
|
|
| HOW DID YOU LEARN OF THE
OPENING?____________________________________ |
| ______________________________________________________________________ |
| |
|
|
PLEASE STATE BRIEFLY YOUR
EXPERIENCES WHICH YOU FEEL WILL BE HELPFUL
WHEN YOU SERVE ON THIS
COMMITTEE:___________________________________ |
| ______________________________________________________________________ |
| ______________________________________________________________________ |
| ______________________________________________________________________ |
| |
| OTHER INFORMATION MAY BE
SUBMITTED BY RESUME IF DESIRED. |
| |
| SUMMARY OF BACKGROUND
& SKILLS:____________________________________ |
| ______________________________________________________________________ |
| ______________________________________________________________________ |
| ______________________________________________________________________ |
| |
| PROFESSIONAL
EXPERIENCE:_____________________________________________ |
| ______________________________________________________________________ |
| ______________________________________________________________________ |
| ______________________________________________________________________ |
| |
|
|
| EDUCATION:___________________________________________________________ |
| ______________________________________________________________________ |
| ______________________________________________________________________ |
| |
| PROFESSIONAL AND/OR
COMMUNITY ORGANIZATIONS:______________________ |
| ______________________________________________________________________ |
| ______________________________________________________________________ |
| |
| PERSONAL INTERESTS &
HOBBIES:_________________________________________ |
| ______________________________________________________________________ |
| ______________________________________________________________________ |
| ______________________________________________________________________ |
| |
| HAVE YOU EVER BEEN
CONVICTED OF A FELONY WHICH WOULD DISQUALIFY YOU FROM
APPOINTMENT? (IF THE ANSWER IS YES, PLEASE LIST THE
NATURE OF THE CONVICTION AND THE DATE AND COURT IN WHICH
THE CONVICTION WAS
ENTERED)_____________________________________________________________ |
| _____________________________________________________________ |
| _____________________________________________________________ |
| _____________________________________________________________ |
| IF YOU ARE APPOINTED, YOU
MAY BE REQUIRED TO BE BONDED FOR YOUR PERFORMANCE. IF YOU
ARE APPOINTED AND CANNOT BE BONDED AS REQUIRED, YOUR
APPOINTMENT WILL BE REVOKED. IF
YOU DESIRE A PERSONAL INTERVIEW OR WISH TO ADDRESS THE
BOARD, YOU MAY CONTACT THE BOARD OF SUPERVISORS OFFICE
DIRECTLY AT (209) 468-3113.
|
| |
PLEASE RETURN APPLICATION
TO:
|
CLERK OF THE BOARD
222 E. WEBER AVENUE, #701
STOCKTON, CA 95202 |
| |
| |
|
|
| |
|
|
| |
|
|
| |
|
|
| |
|
|
__________________________________
SIGNATURE |
|
__________________________________
DATE |
