Fillable Board And Commission Application

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Board And Commission Application

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File type: PDF

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City of Covina
Board and Commission Member Application
*Applications are screened on the basis of information submitted and may be subject to a Livescan as part of the
application process.
Board or Commission applying for:
Is this an application for re-appointment?
Yes: ☐
No: ☐
First Name:
Home Address:
Home Phone Number:
Cell Phone Number:
Email:
Business Name:
Business Address:
Business Phone Number:
Why do you wish to serve the City?
What experience or education have you had relative to this field?
What other City Boards, Commissions, or Committees have you served?
To what civic service organizations do you belong?
How did you become interested in this field?
Will you be able to attend all Board or Commission meetings?
Yes: ☐
No: ☐
Are you willing to file a state financial disclosure statement as required?
Yes: ☐
No: ☐
Are you willing to complete the AB 1234 Ethics Training as required?
Yes: ☐
No: ☐
If you answered no to any of the above questions, please explain:
Signature of Applicant:
Date:
Instructions: Complete this application and return it to the City Clerk’s Office, 125 E. College Street, Covina CA 91723.
If you have any questions please contact the City Clerk’s Office at cityclerk@covinaca.gov or (626) 384-5430.
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Board And Commission Application

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Completed 12 July 2020

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