Fillable CSC-Ap CITY OF LA HABRA

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CSC-Ap CITY OF LA HABRA

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REV 20200212
CITIZENS’ BOARD/COMMISSION
APPLICATION FOR APPOINTMENT
CITY OF LA HABRA
Please complete and submit to the City Clerk Department located in the City Hall Administration
Office at 110 E. La Habra Boulevard, La Habra, CA 90631. Please select the position applying for:
Date Application Received: Application Received By:
LH Resident Verified: Date Verified:
Interview Date: Interview Time:
Date Applicant Notified by Phone: Date Applicant Notified by Letter:
Date Follow-up Letters Mailed: Date Completed:
City of La Habra • 110 E. La Habra Blvd. • La Habra, California • 90631 • T: (562) 383-4030 • F: (562) 383-4474 • www.lahabraca.gov
POSITION:
OTHER POSITION:
APPLICANT’S NAME:
RESIDENCE/BUSINESS ADDRESS:
PHONE:
E-MAIL:
HOW LONG HAVE YOU BEEN A
RESIDENT OF LA HABRA?
OCCUPATION:
EDUCATIONAL BACKGROUND:
MEMBERSHIP OR LICENSE IN PROFESSIONAL OR TECHNICAL ASSOCIATIONS:
MEMBERSHIP IN CIVIC AND OR SERVICE ORGANIZATIONS:
CIVIC INTERESTS:
DO YOU POSSESS ANY SPECIAL SKILLS?:
ADDITIONAL COMMENTS:
It is the policy of the City Council to make appointments to citizens’ committees, boards and commissions on the basis of
interests and qualifications of the applicant. Applicants must be residents of the City of La Habra.
SIGNATURE:
Please do not write below this line – for office use only
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CSC-Ap CITY OF LA HABRA

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Completed 12 July 2020

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