Forms • Emeryville • CivicEngage

Board / Committee / Commission Application

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PERSONAL INFORMATION

Full Name:*

Email Address:*

Gender:

Please specify the Board, Commission or Committee you are applying for:*

I am currently a member of the above Committee, and am seeking reappointment.*

Yes

If you are seeking re-appointment, has any of your information changed within the last 12 months?
If your answer is yes, please complete the rest of this form. If your information has not changed within the past 12 months, please only enter your name and email information above. You do not need to complete the remainder of this form.

Yes

RESIDENCY / EMPLOYMENT INFORMATION

Home Address:

City:

State:

Zip Code:

Home/Cell Phone Number:

How long have you lived in Emeryville?

Place of Employment:

Occupation:

Business Address:

City:

State:

Zip Code:

Business Phone Number:

How long have you worked in Emeryville?

Upload Your Résumé:

EDUCATION / EXTRACURRICULAR INTERESTS

High School:

College:

Trade or Business School(s):

Other Interests:

ADVISORY BODY EXPERIENCE / INFORMATION

Are you currently serving on other Boards, Commissions or Committees?

Yes

Have you served on a Board, Commission or Committee before?

Yes

Please list all past and current City of Emeryville advisory boards.

Please list any past and current board, commission or committee memberships outside of Emeryville.

Please list all organization memberships and positions held.

Please list any relevant work and volunteer experience.

Why are you interested in serving on this Board, Commission or Committee?

PLANNING COMMISSION APPLICANTS ONLY

Please provide a short (300 words or less) statement discussing your ideas and attitudes about planning in Emeryville. Please consider issues such as traffic, industrial and commercial development density, affordable housing, maintaining community diversity and jobs/housing balance.

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