Board and Commission Application

Mar 20, 2018

submission #2

Application Form

Applicant Information

Title	---
Name	---
Home Address	---
What is your length of residence in Monrovia? Please indicate years and months.	---
Cell Phone	---
Email	---
Employer	---
Occupation	---
Business Address	---
Work Phone	---
Educational Background - Please describe any degrees obtained, licenses or special certificates held.	---
Please list any organizations to which you belong (such as Professional, Technical, Civic, etc.).	---
How did you learn about the Board and Commission vacancies?	---

Please check all of the boards or commissions to which you are interested in applying.	Monrovia Old Town Advisory Board (MOTAB)
Are you currently or have you ever been a member of any City board or commission?	Yes.
If yes, please list which one(s) and indicate the start and end dates of service.	---
Why do you wish to serve, or continue to serve, on a board or commission? Why do you believe you are qualified to serve?	---
What experience or special knowledge do you have pertaining to your area(s) of interest to serve?	---
If selected, do you have adequate time available to serve?	---

MOTAB Supplemental Question

Do you have a bona fide business in Old Town that is subject to business improvement district (BID) assessments?

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Certification

Do you agree to the above statement?

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City Review

Application Received

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