Low Graphics Version     
VisitingLivingWorkingDepartmentsCalendarsServices
HomePage > Departments > Elected Officials > CCB Application OnlineE-mail storyPrint friendly format
CCB Application Online Form

APPLICATION to Committees/Commissions/Boards (“CCBs”)

(First Name)(Middle)(Last Name)

Address
Residence
Mailing

Telephone #s
Residence Business Fax
E-Mail

Name and Address of Employer:
Have you ever served on a City of El Segundo Committee/Commission/Board? Yes: No:
If YES, name the Committee/Commission/BoardTerm Served

If you would like to be considered for more than one CCB, please rate the CCB by order of your preference, i.e. 1st, 2nd, 3rd, etc.)


Capital Improvement Program Advisory Committee("CIPAC") Planning Commision
Community Cable Advisory Committee Recreation & Park Commiccion
Economic Development Advisory Council ("EDAC") Senior Citizen Housing Corporation Board
Investment Advisory Committee Other
Library Board of Trustees



Community Services Experience:

ORGANIZATION

From (date)

To (date)

OFFICES HELD

.

...

.

...
....
...

.

Education:

SCHOOL

MAJOR

GRADUATION DATE/DEGREE

...
...

Additional Pertinent Courses or Training:

Other Pertinent, Experience or Interests:

City of El Segundo Application to CCBs Part II

Please furnish brief, written responses to the questions below using additional sheets, if necessary:

1- Why do you think you should be appointed? What is there specifically in your background training, education and interests which qualifies you as a candidate?

2 - What do you see as the objectives/goals of the Committee(s)/Commission(s)/Board(s) you are applying to?

3 -How would you help achieve the objectives and goals?

4 - What reservations, if any, do you have about the Committee(s)/Commission(s)/Board(s)?

5 - Other comments:

6 - Please provide the names, addresses, and telephone numbers of three personal references (other than family members):


Name Address Phone
...
...
...

Signature Date:

For further information call (310) 524-2302. You may fax your competed application to (310) 322-7137 or mail it to City Council, City of El Segundo,
350 Main Street, El Segundo, CA 90245-3895.

Top
Copyright © 2000 - 2008 City of El Segundo, 350 Main Street, El Segundo, CA 90245 · 310-524-2300Powered by