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2. The City currently has two active Commissions/Committees: the Planning Commission and the Measure Z Citizens’ Committee. All commissions/committees consist of five members who shall not be officials or employees of the City. Applicants for the Planning Commission must 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 Citizens’ Committee must legally reside within the City limits (LEMC Section 3.30.160). Each commission/committee serves as an advisory body to the City Council on policy matters or in reviewing specific issues as directed by the City Council or prescribed by law. Members of both the Planning Commission and the Measure Z Citizens’ Committee are appointed by individual City Council Members to represent their respective districts, and applications remain active and on file with the City Clerk’s Office through December 31 of each calendar year and may be considered for vacancies that occur during that time.

4. 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.

6. Additional Resources to Assist in Completing Application
   • View a map showing the City limits (PDF).
   • Find out which City Council District you live in.
10. Commission / Committee Applying For*

    1. Planning Commission
    2. Measure Z Citizen Committee
11. Applicant Eligibility*

    1. City Resident
    2. Business Owner
15. Applicant Information
17. First Name*
18. Last Name*
20. Address*
22. City*
23. State*
24. Zip Code*
26. Phone Number*
27. Email Address*
29. Length of Residency in Lake Elsinore*
30. Length in California*
32. What City Council District do you live in?*

    See City Map (PDF) and City Council Districts to verify.

36. Business Information (if Applicable)
38. Business Name
39. Business Type
41. Business Address
43. Lake Elsinore Business License Number
44. Expiration Date
46. Phone Number
47. Date Business Established
    Date Business Established
51. Education Information
53. Name of School Attended*
54. City & State*
56. Degree Earned*
57. Number of Units Completed
59. Name of School Attended
60. City & State
62. Degree Earned
63. Number of Units Completed
65. Certificates Attained
69. Do you have Economic Interests, such as income, investments, real or personal property, or outstanding loans which might present a potential conflict of interest?*

    1. Yes
    2. No
73. Work History
75. Current Employer
76. Address
78. Dates Worked
    Dates Worked Start Date

    —

    Dates Worked End Date
79. Position
81. Duties Performed
83. Previous Employer
84. Address
86. Dates Worked
    Dates Worked Start Date

    —

    Dates Worked End Date
87. Position
89. Duties Performed
93. References

    Preferably local residents or stakeholders who are qualified to comment on your capabilities

95. Name
96. Address
97. Phone Number
99. Name
100. Address
101. Phone Number
103. Name
104. Address
105. Phone Number
109. Community Service Participation

     Please describe types of service you have performed, if any.

111. Organization
112. Types of Service
114. Organization
115. Types of Service
117. Organization
118. Types of Service
120. Additional Documentation
124. Are you an Officer or Member of a policy-making board of a non-profit organization which receives funding from the City?*

     1. Yes
     2. No
126. If Yes, please list all organizations.
128. Organization
129. Position
131. Organization
132. Position
134. Organization
135. Position
137. Additional Information
141. Have you ever been convicted of violating any Federal, State, County or Municipal law, regulation or Ordinance, excluding minor traffic violations?

     1. Yes
     2. No
143. If Yes, please explain.
147. Why are you interested in serving on this Commission/Committee?*
149. 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.

153. 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.

155. 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.

157. Signature (Please type your name)*
158. Date*
     Date
Leave This Blank:


160. 1. Receive an email copy of this form.
161. Email address

     This field is not part of the form submission.

162. Submit

* indicates a required field