Laserfiche WebLink
Name I' <br />I <br />CY, Mrs., <br />CITY OF SANTA ANA <br />APPLICATION FOR SERVICE <br />BOARDS I COMMISSIONS / COMMITTEES <br />Print Form <br />2Qib ,!i!h! i (39 3 2% <br />LAST <br />Home Address — _ Ward: 2 Qualified Elector: I l S <br />F270 ( <br />This area to be completed by Clerk staff.) <br />Zip Code ®" Home Phone , Fax <br />Cell <br />nE <br />City _ Zip Code ; Work Phone, <br />Soo, Sec. No. "° &,Driver "s License Date of Birth <br />Years Lived /Worked In Santa Ana Language(s) Spoken <br />Organizations <br />3 <br />Qualifications, Experience, Education rl & <br />Remarks (attach resume if available) <br />List Board(s) / Commission(s) 1) Select first choice: <br />you would like to serve on: 2) Select second choice: <br />3) Select third choice: <br />I am a registered voter in the City of Santa Ana. I have completed this application with the knowledge and <br />understanding that any or all items may be verified, and affirm I have received the Ethics Code, understand its <br />provisions, and pledge to conduct my duties consistent with the code if appointed to a City Board or Commission. <br />I consent to the release of information contained in this application to interested parties. I further understand that <br />the Santa Ana Police Department conducf° utme background check on applicants nominated for appointment. <br />SIGNATURE DATE * <br />This field must be completed in order for the application to be processed. <br />This application will be retained on file In the Clerk of the Council Office for 2 years. <br />Please note that the Code of Ethics and Conduct Certification must be signed and received by the Clerk of the Council Office <br />prior to nomination to a commission /board. <br />D - 20