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. Your application and video interview will be available to the 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 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 (If you chose more than one)
* Public Phone or Email:
(If appointed, we provide this information to people upon request)

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