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 Public Utilities Commission*
 Economic Dev. Advisory Committee* Library Board Senior Commission
 Parks & Recreation Commission Personnel Board Roseville Grants Advisory Commission*
 Placer Mosquito & Vector Control District Planning 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

Security Measure