Application for Boards & Committees


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Application for Boards & Committees

Please note: This application is considered to be public record.

To:
Subject:

I am interested in being considered for appointment to the following boards and committees:

Board of Adjustment
Building Board of Appeals
Design Review Board
Downtown Development Committee
Economic Development Advisory Board
Historic Preservation Committee
Housing Advisory Board
Human Relations Advisory Board
Human Services Advisory Board
Industrial Development Authority
Judicial Advisory Board
Library Advisory Board
Merit System Board
Museum & Cultural Advisory Board
Parks & Recreation Board
Personnel Appeals Board
Planning & Zoning Board
Public Safety Personnel Retirement & Pension Boards
Self-Insurance Program System - Board of Trustees
Transportation Advisory Board

Other

Please provide the following information (required information bolded):

Name of Nominee
Home Address
City	State/Province Zip Code
Home telephone
E-mail
Council District	Number of years as a Mesa Resident
Nominated by (if not nominated by self)

Occupation
Business/Company Name
Work Address
City	State/Province Zip Code
Work telephone	Fax Number

Preferred mailing address (Home or Work):

Degree(s) Earned and School Attended (i.e. Bachelor of Science from ASU):

Professional experience (include professional memberships and previous employment):

Community activities (include civic clubs, volunteer activities, service organizations, etc.):

Comments/Special qualifications:

Previous service on City boards/committees (include dates of service):

Why do you want to serve on this board/committee?

If desired, you may cut and paste your resume into the box below:

Optional Information:
Date of Birth
Gender
Ethnic Background
Languages spoken/written