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2. Application for City Commissions/Boards/Committees

   The Monterey Park City Council seeks citizens to serve on duly constituted Boards, Commissions, and Committees to assist and advise City Council on specific assigned matters. No citizen may serve on more than one standing Board, Commission, or Committee at one time. Applications will be kept on file for one (1) year from the date received. For certain boards, annual residency verification is required in accordance to MPMC 2.82. This is a public document and is subject to disclosure. Please direct questions to the City Clerk's office at mpclerk@montereypark.ca.gov.

4. First Name*
5. Last Name*
7. Home Address:*
8. City*
9. Zip*
11. Phone Number*
12. Email Address*
14. If you are a resident of the City, how long have you resided in Monterey Park?
15. Occupation:*
17. Business Name:
18. Business Address:
20. Business Zip Code:
21. Business Phone Number:
23. Commission/Committee or Board on which you want to serve (You may select more than one):*

    1. Commission on Aging
    2. Business Improvement District Advisory Committee
    3. Community Participation Commission
    4. Design Review Board
    5. Economic Development Advisory Commission
    6. Environmental Commission

    1. Library Board of Trustees
    2. Personnel Board
    3. Planning Commission
    4. Recreation & Parks Commission
    5. Sister Cities Commission
    6. Traffic Commission
25. Have you ever been convicted of a felony?*

    1. Yes
    2. No

    If yes, please state the nature of offense, state and disposition on a separate sheet of paper. Convictions will not necessarily result in automatic disqualification, however, failure to give complete and accurate information may be grounds for rejection and/or removal from office. 

27. Prior Community Involvement/Activities:*
29. Provide a brief review of your background, qualifications, education and your interest in serving the City:*
31. List Two References Below
33. First Reference Name:*
34. Reference Phone Number:*
36. Reference Email Address:*
37. Reference Address:
39. 2nd Reference Name:*
40. Reference Phone Number:*
42. Reference Email Address:*
43. Reference Address:

45. I declare under penalty of perjury, under the laws of the State of California, that all statements contained in this application and any accompanying documents is true and correct, with full knowledge that all statements made in this application are subject to investigation and that any false or dishonest answer to any question may be grounds for denial or subsequent revocation of commission. I further acknowledge that information contained in this application is a public record and may be subject to disclosure and I may be required to file a Statement of Economic Interests Form (Form 700). 

47. Signature*
48. Date*
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit Submit and Print

* indicates a required field