Upland City Hall
460 N. Euclid Ave.
Upland, Ca 91786
(909) 931-4100
Monday - Thursday
8am - 6pm
City Clerk
Public Service Aplication for
Authorities, Boards, Committees, or Commissions
Please print out this form, complete and return to the City Clerk's Office located at City Hall, 460 N. Euclid Ave, Upland CA 91786
or
Fax to the City Clerk's Office at (909)931-4123
| Mr. / Mrs. : _________________________________ | Date: __________________ |
General Application for all committees
Specific Application for the following:
When are you available for meetings (Check those which apply)?
Mornings | Afternoons | Evenings
GENERAL INFORMATION
HOME ADDRESS:________________________________________________
HOME PHONE:________________________________________________
E-MAIL ADDRESS:________________________________________________
PRESENT EMPLOYER:________________________________________________
BUSINESS ADDRESS:________________________________________________
BUSINESS PHONE:________________________________________________
POSITION:________________________________________________
ACTIVITIES INFORMATION
Professional Activities:
________________________________________________
________________________________________________
Community Activities:
________________________________________________
________________________________________________
EDUCATION
________________________________________________
________________________________________________
On a separate piece of paper,
explain in 300 words or less your reasons for wanting to serve.
List 3 community references:
1. ________________________________________________
2. ________________________________________________
3. ________________________________________________
______________________________
(Signature)