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Commission Application

Please correct the field(s) marked in red below:

The City of Lake Elsinore Planning/PSAC Commission’s consist of five members who shall not be officials or employees of the City and shall legally reside within the City limits of the City or be the owner of a business that is established and currently licensed inside the City limits (LEMC Section 2.24.020).  Members are appointed to four year terms, by the City Council.

Instructions: Please answer each question completely. This application will be maintained until December 31st of each year. After December 31st, it is necessary to file a new application for another year of eligibility. Please be advised that the City Clerk’s Department uses Voter Registration information for verification of residency. Note: This application is subject to the Public Records Act and may be released to the public.

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Commission Applying For:
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Applicant Eligibility
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Applicant Information
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Applicant Information
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Business Information
Business Information
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Education Information
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Education Information
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Do you have Economic Interests, such as income, investments, real or personal property, or outstanding loans which might present a potential conflict of interest?
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Work History
Work History
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References (Local Residents who are qualified to comment on your capabilities)
References (Local Residents who are qualified to comment on your capabilities)
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Community Service Participation (please describe types of service you have performed, if any)
Community Service Participation (please describe types of service you have performed, if any)
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Are you an Officer or Member of a policy-making board of a non-profit organization which receives funding from the City?
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If Yes, please list all Organizations
If Yes, please list all Organizations
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Have you ever been convicted of violating any Federal, State, County or Municipal law, regulation or Ordinance, excluding minor traffic violations?
Have you ever been convicted of violating any Federal, State, County or Municipal law, regulation or Ordinance, excluding minor traffic violations?
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Interest for Serving on a Commission
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Please note: Appointees will be required to take an Oath of Office and file a completed Statement of Economic Interest form, if appointed to a position specified in the City’s Conflict of Interest Code. Appointees are not considered to be City employees for purposes of benefits, such as workers compensation and health insurance.

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Applicant's Declaration and Signature

I certify under penalty of the perjury laws of the State of California that all information on this form is true and correct.  By typing my name and the date completed on this form, I am affirming my intent to be a candidate for appointment to a Commission for the City of Lake Elsinore. If appointed I pledge to follow the laws of the City of Lake Elsinore, the policies as set forth by the City Council and to conduct myself in such a manner as to be a good representative of the City.

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