PLEASE READ BEFORE YOU BEGIN:

2. Instructions
   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.
4. Position:
   -- Select One --Planning CommissionCommunity Services CommissionOther

   Please select the position applying for.

5. Other Position:
   Please add the position applying for.
7. First Name
8. Last Name
10. Address:
11. City:
13. Telephone:*
14. Email:*
16. How long have you been a La Habra resident?
17. Occupation:
19. Educational Background:
21. Are you the spouse or child of a current City Councilmember, City Manager, or Department Head?*

    1. Yes

    1. No
22. If yes, please identify the person and your relationship to them:
24. Membership or License in Professional or Technical Associations:
26. Membership in Civic and or Service Organizations:
28. Civic Interests:
30. Do you possess any special skills?
32. Additional Comments:
34. It is the policy of the La Habra 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.
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36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit Submit and Print

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