City Forms - Metropolitan Water District Board of Directors Application

* indicates required information

INFORMATION TO BE DISPLAYED ON INTERNET:

Prefix*:
First Name*: Middle Name:
Last Name*:
Public Address:

City: State: Zip:
Phone: format (xxx) xxx-xxxx Fax: format (xxx) xxx-xxxx
E-mail:

Specify current or prior service on City Boards/Commissions:

List Community activities in which you are involved:

Describe your qualifications, experience, and education, and list any technical or professional requirements you have relative to the duties of the Metropolitan Water District Board of Directors.

What are your goals in serving on the Metropolitan Water District Board of Directors?

BUSINESS INFORMATION: OKAY TO DISPLAY ON INTERNET*? Yes No

Occupation*:
Bus. name:
Bus. address:

City: State: Zip:
Phone: format (xxx) xxx-xxxx Fax: format (xxx) xxx-xxxx

FOR CONFIDENTIAL USE ONLY:

Residence Address*:

City*: State*:    Zip*:
Phone*: format (xxx) xxx-xxxx       Cellular: format (xxx) xxx-xxxx
ALL INFORMATION, EXCEPT INFORMATION ENTERED IN THE CONFIDENTIAL SECTION, IS PUBLIC AND AVAILABLE FOR VIEWING AT THE CITY CLERK'S OFFICE AND ON THE CITY'S WEB PAGE (EXCEPT AS NOTED ABOVE).

DISABILITY RELATED ASSISTANCE AND ALTERNATE FORMATS OF THIS DOCUMENT ARE AVAILABLE UPON REQUEST BY CALLING (310) 458-8211