NEPOTISM FORM

Registration Number / Applicant Last NameFirstMiddle

NEPOTISM

  1. Is a member of your immediate family (spouse, parent, child, brother, sister, in-law, uncle, aunt, nephew, niece, first cousin, step-parent, step-child) an elected City or County official?

 Yes NoIf yes, what is his/her name, elected title and relationship to you?

  1. Is a member of your immediate family (spouse, parent, child, brother, sister, in-law, uncle, aunt, nephew, niece, first cousin, step-parent, step-child) an employee of a City, County or WIA funded organization?

 Yes NoIf yes, what is his/her name, organization, position and relationship to you?

The Riverside County Economic Development Agency (EDA), as a recipient of federal and state funds, is an equal opportunity employment program and is subject to Section 504 of the Rehabilitation Act and the Americans with Disabilities Act (ADA) and Section 188 of the Workforce Investment Act, and their implementing regulations.
You can obtain information about accommodations for disabilities by contacting your local EDA office, the number is 951.955.3100.
Hearing-impaired persons can reach Riverside County Economic Development Agency through the TDD service, 951.955.9050.

CSU 448-53 (Rev. 10/13/11 kt)

NEPOTISM FORM

Registration Number / Applicant Last NameFirstMiddle

NEPOTISM

  1. Is a member of your immediate family (spouse, parent, child, brother, sister, in-law, uncle, aunt, nephew, niece, first cousin, step-parent, step-child) an elected City or County official?

 Yes NoIf yes, what is his/her name, elected title and relationship to you?

  1. Is a member of your immediate family (spouse, parent, child, brother, sister, in-law, uncle, aunt, nephew, niece, first cousin, step-parent, step-child) an employee of a City, County or WIA funded organization?

 Yes NoIf yes, what is his/her name, organization, position and relationship to you?

The Riverside County Economic Development Agency (EDA), as a recipient of federal and state funds, is an equal opportunity employment program and is subject to Section 504 of the Rehabilitation Act and the Americans with Disabilities Act (ADA) and Section 188 of the Workforce Investment Act, and their implementing regulations.
You can obtain information about accommodations for disabilities by contacting your local EDA office, the number is 951.955.3100.
Hearing-impaired persons can reach Riverside County Economic Development Agency through the TDD service, 951.955.9050.

CSU 448-53 (Rev. 10/13/11 kt)