Boards/Commissions/Committees Application

Indicate your interest by selecting no more than two from the following list of City Council appointed Boards/Commissions/Committees. The application process includes a video interview. If appointed, your application will be made available to the press and public.

*Indicates Statement of Economic Interests (Form 700) is required.

 Board of Appeals Design Committee
 Economic Dev. Advisory Committee* Library Board
 Parks & Recreation Commission Personnel Board
 Placer Mosquito & Vector Control District Planning Commission*
 Public Utilities Commission* Roseville Grants Advisory Commission*
 Senior Commission Transportation Commission*
* Name 
* Home Address 
* City 
* Zip Code 
Home Phone 
Work Phone 
Cell Phone 
* Email Address 
* How long have you lived in Roseville? 
List any relatives working for the City of Roseville 
* Are you a Placer County registered voter? 
* Are you presently serving on any other City of Roseville Board/Commission? 
* Do you have any relatives on the same board or commission you are applying? 
* Occupation (If retired, indicate former occupation) 
* Employer 
Employer Address 
* Education 
* Professional/personal civic, philanthropic, community affiliations and interests 
Additional pertinent information/references 

Why are you interested in serving on this board/commission/committee?

* Choice #1 
* Choice #2 

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