Commissioner Application Form

Commissioner Application Form

CITY OF ROSEMEAD
COMMISSIONER APPLICATION

 

Please select which Commission(s) you are interested in applying for:

 

Name:  

Address:  

Cell Phone #:   Home Phone #:  

E-mail:  

Are you a registered voter in the City of Rosemead?   Yes    No


How long have you lived in Rosemead?     In California?  

Employer's Name: 

Type of Business: 

Educational Background:

Name of School/CollegeYear
Graduated
Degree or
Certificate Obtained

 

Why are you interested in serving as a Commissioner? Please describe any work, training, certificates, and/or mentorship in professional organizations that would qualify you for this position.

 

Personal or business activities that would be in conflict with you serving as a Commissioner:


 I hereby certify by checking this box, constitutes a legal signature confirming that all statements in this application are true and correct to the best of my knowledge. I understand that this document is a public record subject to disclosure under the Public Information Act.

Please type your First and Last Name:      Date:  



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