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Commission/Committee Application

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

The City currently has three standing Commissions/Committees: the Planning Commission, the Public Safety Advisory Commission (PSAC) and the Measure Z Citizen Committee. All commissions/committees consist of five members who shall not be officials or employees of the City. Applicants for the Planning/Public Safety Advisory Commission shall legally reside within the City limits or be the owner of a business that is established and currently licensed within the City limits (LEMC Section 2.24.020). Applicants for the Measure Z Citizen Committee must legally reside within the City limits. Each commission/committee serves as an advisory body to the City Council on policy matters or reviewing specific issues as directed by the City Council or prescribed by law. Currently, all Planning and Public Safety Advisory Commissioners are appointed at-large by a City Council Subcommittee. However, members of the Measure Z Citizen Committee are appointed by-district by their elected council representative. 

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.

Additional Resources to Assist in Completing Application: 

City Map: To view a map showing the City limits, please click here.  

City Council Districts: To find out which City Council District you live in, please click here.

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Commission/Commitee Applying For:
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Commission/Commitee 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 (if applicable)

Business Information (if applicable)
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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 (preferably local residents or stakeholders who are qualified to comment on your capabilities)
References (preferably local residents or stakeholders 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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Why are you interested in serving on this Commission/Committee?
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Please list any qualifications you may have to serve on the Commission/Committee you are applying for, i.e. education, related service or work experience, budgeting or financial experience, community involvement, etc. (For example, if you are applying for the Measure Z Citizen Committee, please list any financial or budgeting experience)  
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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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