CITY OF MILPITAS COMMISSION/COMMITTEE APPLICATION

For residence of Milpitas, California ONLY.

COMMISSION/COMMITTEE APPLYING FOR: *
Name Name First Middle Last
Address Type

Address Type Residence Business
Address
City
Postal/Zip Code
Mobile Number Mobile Number - ### - ### ####
E-Mail Address *
Present Employer
Other Phone Other Phone - ### - ### ####
Business Address (Optional)
City
Postal / Zip code
Occupation
Education: If Youth Advisory Commission applicant, indicate your grade/school:
College, Professional, Vocational, or other schools attended
Major Subject
Degree
List community organizations to which you belong or have belonged (additional information may be attached).
Name of Organization
Member
Name of Organization
Member
Name of Organization
Member
If application is for Veterans Commission, indicate branch and service in any U.S. military organization (retired or active duty).
Branch of Military
Officer
Briefly describe the personal qualifications you possess which you believe would be an asset (additional information may be attached):
Upload a File

Attach Files
Date Date / MM / DD YYYY
I have sufficient time to devote to this responsibility and will attend the required meetings if I am appointed to fill a future vacancy. I hereby certify that all statements contained in this application are true.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Appointments to Commissions or Committees are made by the Mayor with the concurrence of the City Council. Applications not acted upon will expire after one year from the date submitted unless renewed by the applicant. Once submitted, your application will be submitted to the City Clerk.

NOTE: ALL COMMISSION APPLICATIONS ARE PUBLIC RECORD

Spam Protection. Please answer this simple question.
What is "eleven" as a number?

CITY OF MILPITAS COMMISSION/COMMITTEE APPLICATION

CITY OF MILPITAS COMMISSION/COMMITTEE APPLICATION

List community organizations to which you belong or have belonged (additional information may be attached).

If application is for Veterans Commission, indicate branch and service in any U.S. military organization (retired or active duty).

Appointments to Commissions or Committees are made by the Mayor with the concurrence of the City Council. Applications not acted upon will expire after one year from the date submitted unless renewed by the applicant. Once submitted, your application will be submitted to the City Clerk.