APPLICATION FOR APPOINTMENT TO A COUNTY ADVISORY BODY

INSTRUCTIONS:

If you are interested in serving on a County advisory body, please complete this application and return it to the Board of Supervisors, 701 Ocean Street, Room 500, Santa Cruz, CA 95060. If you are interested in being considered for appointment to more than one advisory body, a separate application must be submitted for each appointment you are seeking. Please note: This application is a public document and will be disclosed upon request. In addition, copies of applications of those selected for appointment will be included in the Board's printed agenda packet.

Upon receipt, your application will be routed to each Board member and then filed for further consideration by Board members when there is a vacancy on the advisory body. If a Supervisor is interested in nominating you for appointment, you will be contacted to discuss the appointment, the appointment process, and requirements for the advisory body in question.

Please specify the Commission, Committee or Board to which you are seeking appointment and provide the requested information. Please note that some Commissions, Committees and Boards have specific categories of representation. For information on current vacancies and categories of representation, please visit the County's website at www.co.santa-cruz.ca.us or call the Clerk of the Board's office at 454-2323.

Thank you for your interest in County Government.
Commission, Committee, or Board:   
If applicable, please indicate the category of representation for which you are seeking appointment (see above)
Name:   
Street:   
City:   
State:   
Zip Code:   
Email Address:   (required:email address
Phone (Home):                        OR
Phone (Business):          phone number)
Supervisorial District:   
Length of Residence in Area:   
Age (optional):   

PREVIOUS COMMISSION OR COMMITTEE SERVICE (Please Specify):

Advisory Body    

Term    

EDUCATION:
Institution     Major     Degree     Year    

WORK/VOLUNTEER EXPERIENCE:
Organization     Address     Position     Years    

STATEMENT OF QUALIFICATIONS:

Please complete a brief statement indicating why you are interested in serving on the advisory body in question and why you are qualified for the appointment:

 

CERTIFICATION:

By checking this box and entering the date, I certify that the above information is true and correct and authorize the verification of the information in the application in the event I am a finalist for the appointment.

     Date:    (required: date and checkbox)