Form Center

* indicates a required field

2. Note:

   Your application / biographical information will be copied for the City Council and made available to the press and public. 

4. Personal Data
6. First Name*
7. Last Name*
9. Email address*
10. Phone Number*
12. Address*
    Applicants must be a resident of the City of Citrus Heights.
14. City*
15. State*
16. Zip*
18. Are you presently serving on a City commission or board?*

    1. Yes
    2. No
19. If yes, which commission or board?
20. How long have you lived in Citrus Heights?*
22. Employment / Experience
24. Employer
25. Occupation
    If retired, please indicate former occupation or profession.
27. Education
29. What skills, training, or experiences do you feel you have that would benefit this board or commission?
31. What are some of your goals and visions for the City and what do you hope to gain from your board/commission experience?
33. Have you ever had previous public service experience on a commission or public body? Please explain.
35. Please list any community volunteer activities and/or current memberships in civic organizations, service clubs, etc. in which you are involved:
37. AB 1234 Ethics Training:

    Every newly appointed board or commission member is required to complete the AB 1234 Ethics Training required by California Government Code 53234 within the first year of appointment and every two years thereafter. Noncompliance will result in automatic removal as detailed in the City Council Handbook (adopted January 2023).

39. AB 1661 Sexual Harassment Prevention Training and Education:
    Every newly appointed board or commission member is required to complete the AB 1661 Sexual Harassment Prevention and Education required by California Government Code 53237.1 within the first six months of appointment and every two years thereafter.
41. Statement of Economic Interest Form 700:
    Pursuant to the Political Reform Act and the City's Conflict of Interest Code public officials are required to file a Statement of Economic Interest Form 700 upon appointment / assuming office.
43. Applicant Acknowledgement*

    By submitting this form, I hereby declare, under penalty of perjury, that all statements in this application are true and complete to the best of my knowledge and belief.

    1. Please click here once you have read this statement.
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.