TOWN OF SAN ANSELMO
APPLICATION FOR APPOINTMENT TO A SAN ANSELMO BOARD/COMMISSION/COMMITTEE
To: San Anselmo Town Council
Date*
I wish to apply for an*
Select
Art Commission
Board of Review
Capital Program Monitoring Committee
Flood Committee
Historical Commission
Library Advisory Board
Library Parcel Tax Oversight Committee
Open Space Committee
Parks & Recreation Commission
Planning Commission
Quality of Life Commission
Tax Equity Board
Economic Development Committee
Ross Valley Paramedic Authority
Name*
Home Address*
Occupation*
Employer's Address
Home Phone*
Work Phone
Cell Phone
E-Mail*
Number of years as resident of San Anselmo*
Number of years as a resident in Marin*
Education Level Achieved*
Select
Graduate Degree (Major)
College/University Degree (Major)
Some College
High School Diploma
Other (Explain)
Name and phone numbers of three San Anselmo residents who can be contacted for referral information about me:
1.) Name*
1.) Phone*
2.) Name*
2.) Phone*
3.) Name*
3.) Phone*
I would be able to regularly attend the meetings of this Board/Commission/Committee.*
I would be available to attend additional meetings when they are necessary.*
I am familiar with the responsibilities and functions of this Board/Commission/Committee.*
I have attended meetings of the Board/Commission/Committee as a member of the public.*
List briefly, previous experience serving the public office, and/or civic commissions,boards, or comittees.*
Reasons for this appointment.*
What are your qualifications for this appointment.*
Briefly, what do you consider to be the most important, one or two current issues facing this Board/Commission/Committee?*
I understand that I and all other applicants will be personally interviewed by the Town Council as part of the selection process for this appointment. I also understand that my application material will be a public document and available on the Town's website. Sensitive materials that you don't wish to be posted on the website should not be included with the application.*
Other Boards/Commissions/Committees on which you would be interested in serving if not appointed to this seat?*
Select
None
Art Commission
Board of Review
Capital Program Monitoring Committee
Flood Committee
Historical Commission
Library Advisory Board
Library Parcel Tax Oversight Committee
Open Space Committee
Park & Recreation Commission
Planning Commission
Quality of Life Committee
Tax Equity Board
You may attach personal resumes or other information which you believe would be helpful to the Council in its selection process.
(GIF, JPG, JPEG, PNG, DOC, DOCX, XLS, XLSX, TXT)
Thank you for your interest in serving the Town of San Anselmo and its citizens. For further information, please contact Carla Kacmar, at ckacmar@townofsananselmo.org or 415-258-4691.
* indicates required fields.
