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PENINSULA CORRIDOR JOINT POWERS BOARD
1250 SAN CARLOS AVENUE, SAN CARLOS, CA 94070
Please type or print using dark ink.
NAME ________________________________________________________________
HOME ADDRESS _____________________________________________________________
BUSINESS ADDRESS _________________________________________________________
E-MAIL ________________________________________ FAX NUMBER __________________
PLEASE CHECK ONE: __EMPLOYED __UNEMPLOYED __STUDENT __RETIRED
PRESENT OCCUPATION _________________________________________________
ARE YOU A CALTRAIN RIDER?
HOW OFTEN DO
YOU RIDE? ____ Daily Commuter (4-5 times a week)
____ 1-3 times a week
____ Occasionally/weekends
ARE YOU ABLE AND WILLING TO DEFINE AND EVALUATE
ISSUES WITHOUT EXPRESSING A PERSONAL BIAS? _______________________
ARE YOU WILLING TO MAKE A CONSCIENTIOUS EFFORT TO
GIVE MEMBERSHIP TO THIS COMMITTEE A PRIORITY AND PARTICIPATE AS NECESSARY?
______________
IF YOU ARE PRESENTLY ACTIVE, OR HAVE BEEN ACTIVE IN
THE PAST FIVE YEARS, IN ANY ORGANIZATION, PLEASE GIVE THE ORGANIZATION
NAME, NATURE OF YOUR ACTIVITIES AND DUTIES, AND APPROPRIATE
DATES:
______________________________________________________________________
______________________________________________________________________
WHAT OTHER FORMS OF TRANSPORTATION DO YOU USE?
______________________________________________________________________
______________________________________________________________________
WHAT SPECIALIZED SKILL OR EXPERTISE WOULD YOU BRING
TO THE CAC?
______________________________________________________________________
EDUCATIONAL
BACKGROUND:
List highest
grade completed, any degrees you hold and the college/university attended
and date of graduation.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
EMPLOYMENT
BACKGROUND:
List
employment history for the past five years, including positions and titles
held:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
WHY DO YOU WISH TO BE CONSIDERED FOR MEMBERSHIP ON
THE CAC?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
RESUME MAY BE ATTACHED TO APPLICATION.
APPLICATION MUST BE RECEIVED BY MAY 15, 2007
Please send completed application to:
Assistant Board
Secretary
Peninsula
Corridor Joint Powers Board
PO Box 3006
San Carlos, CA 94070-1306
FAX
650.508.6281
Phone
650.508.6223
e-mail: laker@samtrans.com
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