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Citizen's Transportation Sales Tax Commission Application
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Boards, Commissions & Committees Application
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Comprehensive Fees Task Force
If other, please specify:
First Name
Last Name
Address
City
State
Zip Code
Home Phone
Work Phone
Email Address
Occupation
Employer / Business
Business Address
City
State
Zip Code
Education
Qualifications:
Are you a Modesto resident?
Yes
No
If yes, what was the date of residency?
If yes, what was the date of residency?
Are you a registered voter in the City of Modesto?
Yes
No
Are you a registered voter in Stanislaus County?
Yes
No
Are you now or have you ever been employed by the City of Modesto?
Yes
No
If yes, in what capacity?
Inclusive dates:
Inclusive dates: Start Date
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Inclusive dates: End Date
Do you have relatives or a member of your household who are employed by the City of Modesto, or who are currently serving on the City Council, or who are Board members or Commissioners?
Yes
No
If yes, please explain:
List relevant employment, training, and experience, certificates of training, licenses, and professional registration.
How did you learn about the board for which you are applying?
Community Group
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Place of Employment
Utility Bill Insert
Other (Please specify)
If other, please specify:
Describe your involvement in community activities and civic organizations. (Do not list partisan political parties.)
What is it about this position that interests you?
What qualities, experience, and expertise would you bring to it?
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