Application for Commission/Committee Position Openings

Pod March 3, 2020

There are currently no commission or committee vacancies.

Paper version of Application for Boards & Commissions

BOARD OR COMMISSION YOU'RE APPLYING FOR: *

NAME: *

HOME ADDRESS: *

HOME TELEPHONE NUMBER: *

EMAIL: *

OCCUPATION: *

BUSINESS ADDRESS:

BUSINESS TELEPHONE NUMBER:

DO YOU LIVE WITHIN CITY LIMITS?: *

YES

LENGTH OF RESIDENCY IN THE GRASS VALLEY AREA?:

ARE YOU CURRENTY SERVING ON A BOARD/COMMISSION?: *

YES

IF YES, WHICH BOARD/COMMISSION:

WHAT SPECIAL SKILLS OR BACKGROUND DO YOU BRING TO THE BOARD OR COMMISSION?:

WHAT DAYS OF A TYPICAL MONTH ARE YOU UNABLE TO ATTEND MEETINGS:

ARE YOU INVOLVED IN ANY ACTIVITIES THAT MIGHT CREATE A CONFLICT OF INTEREST?: *

WHY DO YOU WANT TO BE A MEMBER OF THIS BOARD/COMMISSION?:

PERSONAL REFERENCE

PERSONAL REFERENCES, NOT RELATIVES, WHO CAN SPEAK TO YOUR QUALIFICATIONS TO SERVE.

REFERENCE #1:

NAME, ADDRESS, PHONE NUMBER

REFERENCE #2:

NAME, ADDRESS, PHONE NUMBER

EMPLOYMENT HISTORY

EMPLOYER:

EMPLOYER, ADDRESS, DATES, POSITION

EMPLOYER:

EMPLOYER, ADDRESS, DATES, POSITION

ATTACHMENTS:

CERTIFICATION OF APPLICATION

I hereby submit my application for the position indicated. I understand that the City will verify information contained herein and may make other inquiries, which it deems appropriate to consideration of my application, and I consent to such inquiries.

AUTHORIZE:

YES

SIGNATURE: *

FOR QUESTIONS ABOUT POSITION PLEASE CONTACT THE CITY CLERK: 530-274-4716

The City of Grass Valley does not discriminate on the basis of race, color, religion, sex, national origin, age or handicapped status in the admission, access or appointment to, or treatment or employment in, its programs or activities.

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