Application for Appointment to City Commission/Committee

Please use this form to apply for a City Commission/Committee vacancy. Applicant must be a La Cañada Flintridge resident Disclosure: Please note that this form is a record subject to disclosure under the California Public Records Act.

Name of Commission/Committee:(Required)

Date(Required)

Are you currently serving on this Commission/Committee and applying for reappointment?(Required)

Yes

Personal

Name(Required)

Name

Address(Required)

Street Address Suite / Unit # City ZIP Code

Phone Number(Required)

Email(Required)

Address(Required)

Number of years lived in LCF:(Required)

Please enter a number from 0 to 100.

Education

Please describe your education and any related training you possess which would be relevant as a Commission/ Committee member.(Required)

Please describe your relevant experience and skills.(Required)

Please outline your involvement in community activities, organizations, and civic engagements.(Required)

Other Information

Include a brief statement outlining your views on the roles and responsibilities of this Commission/Committee. Include key issues you believe are important and detail your goals if appointed.(Required)

If applicable, include the Commission/Committee on which you have served previously and include the time frame

Attach a current resume (optional)

Drop files here or

Max. file size: 28 MB, Max. files: 5.

**AUTHORIZATION AND RELEASE** I acknowledge that the information provided in this application is considered a public record and may be subject to disclosure. I understand that, if appointed, I must take an oath of office. Additionally, I am aware that I may be required to file financial disclosure statements (Form 700). I also recognize that completing ethics training is mandatory. I also recognize and agree that the City will issue a City email account through Microsoft 365 to be used exclusively for all City-related business as a commissioner. I recognize the email system will require multi-factor authentication utilizing a mobile device authentication application. I recognize that the City will not issue you any mobile devices for such authentication, and you agree to use your own mobile device for authentication purposes. I recognize that I will not be permitted to forward/use any alternative email accounts not issued by the City for City-related business as a commission.

Type Your Name as the Applicant’s Signature(Required)

Electronic Signature of Applicant