To apply online, fill out the form below. If you would prefer to apply via postal mail or fax, you can download and print out the application form in PDF format instead.

Select the committee/commission on which you wish to serve:

Please fill out a separate application for each committee/commission you are applying for.
Name:
Home phone:
Address:
City: Zip:
Email:
Fax:
Occupation:
Years lived/worked in Fullerton:
Employer:
Work phone:
Address:
City: Zip:
Educational background/degrees:
Licenses or special certificates:
Have you ever been convicted of a crime since your 18th birthday? No Yes
If your answer is yes, please indicate, in the space below, for each offense: (1) Date, (2) Offense, (3) Place, (4) Action taken. Please note that a conviction is not an automatic bar to appointment. What you were convicted of, how long ago and your conduct since the offense will be considered in terms of appointment.
List any Fullerton, Orange County or other city committee or commission on which you have served, and the year served:
Organizations to which you belong (professional, technical, community, service)
Briefly state why you wish to serve on a committee or commission, and why you believe you are qualified for the position. Be specific.
How did you learn about this committee/commission opening?
Local References
1) Name:
Address:
Phone:
2) Name:
Address:
Phone:
3) Name:
Address:
Phone:

I understand that any or all information on this form may be verified. I consent to the release of this information for publicity purposes. Some commissions/committees require filing of ongoing Statements of Economic Interest. (Check box to indicate agreement)

All data supplied on this application is considered public information.