City of San Juan

Application for Appointment

Date:

Board / Commission / Committee:

Name:

Mailing Address:

Preferred Phone and Fax:

Employer:

Occupation:

Email Address:

Are you or can you be qualified to vote in a City of San Juan Election?

Are you a City of San Juan resident? How long?

Have you ever represented any other private person, group or entity for compensation before the City Commission or any department, commission, board of committee within the last three years?

Do you, your spouse, or your employer have any financial interest, direct or indirect in any contract with the City?

Do you, your spouse, or your employer have any financial interest, direct or indirect in the sale to the city of any land, materials, supplies or service?

List of professional or social membership(s)

Experience/ Knowledge Pertaining to Board/ Commission/ Committee of Interest:

Application will be kept on file for two (2) years: thereafter applicants must reapply. Applications may be faxed (956) 787-5978, mailed to the City Secretary (709 S. Nebraska, San Juan, TX 78589) or emailed to bescalante@sjtx.us