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						Application For Advisory Appointment
						


                        Please fill out all the required fields. Otherwise, you would not be able to 
						submit the form.
						

						
						

						

              			

						
First Name:
						
						
						

						
Middle Name:
						
						

					    
Last Name:
						
						
						

						
Address:
						
						
						

						
City:
						
						
						

						
State:
						
						
						

						
Zip Code:
						
						
						

						
Home Phone:
						
                        Format: (xxx) xxx-xxxx
						
						
						

						
Business Phone:
						
                        Format: (xxx) xxx-xxxx
						
						
						

						
Gender:
						
                            
						

						
E-mail:
						
						
						

                        


              			

						

How long have you been a resident of the City of Cupertino?

                        

						

Occupation:

						

						
						

                       
						

Education (Select highest year completed):
						

						

	

		
	



						

						

							

								
								
								
									Name of School
								
								
									Major
								
								
									Years/Credit
								
							

							

								
									High School
								
								
									
								
								
									
								
								
									
								
							

							

								
									Junior College
								
								
									
								
								
									
								
								
									
								
							

							

								
									University
								
								
									
								
								
									
								
								
									
								
							

							

								
									Business/Trade School
								
								
									
								
								
									
								
								
									
								
							

							

								
									Other Training
								
								
									
								
								
									
								
								
									
								
							

						

                        
                        

Professional Licenses or Registrations:

						

						

On which Advisory Commissions, Committees, or Boards would you like to 
						serve?
(List in order of preference. List no more than two):

						

						
						

What public office or offices do you currently hold?

						

						

Please list your qualifications for this position:

						

						


						Are there any special interests or activities that you wish to bring to the 
						attention of the City Council?
(These need not be directly related to the 
						appointment that you are seeking.)

						

						

Do you have any obligations that might affect your regular attendance at 
						scheduled evening meetings?

						

						

Where did you hear about the commission vacancy?

						

						


						The space below is provided for any additional comments that you may wish to 
						make about yourself or the position being sought.

						

						

                        

						

                        

                        
                        



						If you are not selected at this time, we will keep your application on file 
						for a one (1) year period for consideration should a commission 
						vacancy occur.
						

						

						
						I certify that I am not an official or employee of the City of Cupertino, nor 
						related by blood or marriage to any official or employee of the City of 
						Cupertino.						

						

						I understand that all information provided on this form becomes a public 
						record.
						

						

						I understand that all applicants appointed to any commission or committee will 
						be required to file statements of Economic Interest, which are also a public 
						record.

						

						

						

						
						

						

						Note: Please fill out all the required fields. Otherwise, you 
							would not be able to submit the form.