Board of Supervisors (650) 363-4653 COUNTY OF SAN MATEO County Government Center * Redwood City * California 94063 APPLICATION FOR BOARDS, COMMISSIONS AND COMMITTEES Name of Board, Commission, or Committee: Postmark or file by: COMMISSION ON DISABILITIES   Special Requirements (if any): RESIDENT OF SAN MATEO COUNTY - DAY MEETINGS Information provided on this application is public information and may be made available to other applicants, members of the press, or the general public. Would you be able to attend Day Meetings?______ NAME __________________________________________ PHONE ___________________ ADDRESS _______________________________ CITY________________ ZIP__________ PRESENT EMPLOYER_____________________________ POSITION ________________ ADDRESS _______________________________ CITY _______________ ZIP __________ EDUCATIONAL BACKGROUND _____________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ EMPLOYEE AND/OR PROFESSIONAL EXPERIENCE ____________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ CIVIC AND VOLUNTEER ACTIVITIES (Please include any present or past membership on County or City board, committees, as well as participation in the activities of community groups or organizations) __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ WHY ARE YOU SEEKING THIS APPOINTMENT? (Please include in your response any qualifications/special interest related to this position which may not have been covered) __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ HOW DID YOU BECOME AWARE OF THE OPENING? __________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Date ___________________________ Signature ___________________________________ This application may remain on file for six months from the date of submission. PLEASE COMPLETE AND RETURN TO: San Mateo County Commission on Disabilities Craig McCulloh 225 - 37th Avenue San Mateo,CA 94403 For additional information about this board, commission or committee, please contact: San Mateo County Craig McCulloh 225 37th Avenue San Mateo,CA 94403 (650) 573-2580 Back