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Application for Appointed Board or Commission
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Application for Appointed Board or Commission
Placer County Board of Supervisors
I understand, by submitting this application, that the information provided may be publicly available
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Name
*
Home Address
*
City
*
Zip Code
*
Home Phone
*
Phone
form field Home Phone
must be in the format: (000) 000-0000
Work Phone
Phone
form field Work Phone
must be in the format: (000) 000-0000
Cell Phone
Phone
form field Cell Phone
must be in the format: (000) 000-0000
Email Address
*
Email
form field Email Address
is not in correct form
Board or Commission for which you are applying
*
Value is not selected
-- Select one --
Agricultural Commission
Area 4 Agency on Aging Advisory Council
Bond Screening Committee
Building Appeals Board
Cemetery District of Auburn
Cemetery District of Colfax
Cemetery District of Gold Run
Cemetery District of Lincoln
Cemetery District of Newcastle/Rocklin/Gold Hill
Cemetery District of Roseville
Cemetery District of Tahoe
Civil Service Commission
County Audit Committee
County Parks Commission
Deferred Compensation Committee
Eastern Placer County Joint Powers Authority Board
Economic Development Board
First 5 Placer Children and Families Commission
Fish and Game Commission
Flood Control & Water Conservation District Board of Directors
Greater Auburn Area Fire Safe Council
Historical Advisory Board
Housing and Dangerous Buildings Appeal Hearing Panel
In Home Support Services Advisory Committee
Library Advisory Board
MAC - Horseshoe Bar/Penryn Area
MAC - Newcastle Ophir
MAC - Olympic Valley
MAC - Sheridan
MAC -Donner Summit
MAC Foresthill Forum Advisory Council
MAC -Granite Bay
MAC- North Auburn
MAC- North Tahoe Regional
MAC -of West Placer
MAC -Rural Lincoln
MAC-Central
MAC-Meadow Vista
North Auburn/Ophir Fire Safe Council
Olympic Valley Design Review Committee
Placer County Assessment Appeals Board
Placer County Behavioral Advisory Board
Placer County Child Care Advisory Council
Placer County EIFD Public Finance Authority No. 1
Placer County Housing Development Advisory Taskforce
Placer County Law Library
Placer County Older Adult Advisory Commission
Placer County Resource Conservation District
Placer County Transportation Planning Agency
Placer County Youth Commission
Placer Mosquito & Vector Control District
Placer Sierra Fire Safe Council
Planning Commission
RDA Oversight Board of The Successor Agency
Solid Waste Local Task Force
Tahoe Basin Design Review Committee
Veterans Advisory Council
Veterans Memorial Hall Board of Auburn
Veterans Memorial Hall Board of Colfax
Veterans Memorial Hall Board of Foresthill
Veterans Memorial Hall Board of Lincoln
Veterans Memorial Hall Board of Loomis
Veterans Memorial Hall Board of Roseville
Wastewater Advisory Committee
Position for which you are applying
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Supervisorial District of your primary residence
*
Value is not selected
-- Select one --
District 1
District 2
District 3
District 4
District 5
How long have you lived in Placer County?
*
Find Your Supervisor District
List any relatives working for Placer County Government
Are you presently serving on any other Placer County Board/Commission?
*
Yes
No
If so, please name
*
Do you have any relatives on the same board or commission for which you are applying?
*
Yes
No
List any conflicts you may have with serving on this board
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Occupation (If retired, indicate former occupation)
*
Employer
Employer Address
Education
Professional/personal civic, philanthropic, community affiliations and interests
Additional references or information that you deem helpful to your application
Why are you interested in serving on this board/commission/committee?
What background do you have that could benefit serving in this position?
Public Phone and/or Email (if appointed, we provide this information upon request)
Upload your Resume or CV if available
Form field Upload your Resume or CV if available has
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Signature
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Type
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Signature
form field Signature
is required
Date
*
Date
form field Date
must be in the format: MM/dd/yyyy
Email Address:
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