BOARD OF
SUPERVISORS
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Position
Personal Information
Title
First Name
Last Name
NOTE: Your personal information will only be used for verification purposes
Date of Birth
Email Address
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Addresses
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City
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County District
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Phone Numbers
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References
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First Name
Last Name
Email Address
Phone Number
Address
General Information
How long have you lived in Fresno County?
Years
Months
Do you have any obligations that might affect your attendance at scheduled meetings?
Yes
No
Are you a County employee?
Yes
No
County Departments
Is your spouse a County employee?
Yes
No
Spouse County Departments
Current Employer
Education
High School
College Degree
Master Degree
Doctoral Degree
Other
Are you currently an officer or member of a policy-making board of a nonprofit organization founded by the County of Fresno?
Yes
No
County Non-Profit Organizations
Is your spouse currently an officer or member of a policy-making board of a nonprofit organization founded by the County of Fresno?
Yes
No
Spouse County Non-Profit Organizations
Are you a US Citizen?
Yes
No
Country of Citizenship
Reason For Applying
Why do you want to become a member of a County Board, Commission, or Committee?
Qualifications
Please list your qualifications applicable for appointment
Interests Or Activities
Are there any interests or activities that you wish to bring to the attention of the Board of Supervisors?
Previous Appointments
List past or present County appointments, as well as any other public service appointments or elected positions held (please list dates served)
Experience
What experience or special knowledge can you bring to your area(s) of interest?
Community Organizations
List community organizations to which you belong
Convictions And Penalties
Have you ever been convicted of a felony? If yes, give dates(s), location(s) and penalties. (Convictions are evaluated for each position and are not necessarily disqualifying.)
Affiliations
List any affiliation you or your spouse has with public service agencies
Additional Information
This space is provided for any additional information you may have about yourself or the position being sought
Agreements
I have read the
Fresno County Board of Supervisors' Administrative Policy No. 35
regarding conflicts of interest for Board appointees and agree to abide by the policies and procedures at all times while an appointed member of the interested named board, commission, or committee. At present, to the best of my knowledge, no conflicts of interest exist in my serving on this board, commission, or committee.
I acknowledge I may be required to file Statements of Economic Interests (Form 700s) disclosing certain types of information so the public can be made aware of potential conflicts of interest. The types of required disclosures may include: Business Positions; Gifts; Investments; Investments held by a Business Entity or Trust; Interests in Real Property held by a Business Entity or Trust; Income, including Travel Payments, Advances, and Reimbursements; Income and Loans to a Business Entity or Trust; Income from Rental Property; Commission Income received by Brokers, Agents, and Salespersons.
I declare the foregoing information provided on this application is true and correct to the best of my knowledge.
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Applications are valid for one year.
After one year, please submit a new application if you have not been appointed and are still interested in serving on this board, commission, or committee.
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