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2. Individuals interested in serving on the Human Rights Commission must complete this application form. Please be concise.

   For additional questions regarding commission membership, please email COB@co.humboldt.ca.us or call 707-476-2390.

   To learn more about the Human Rights Commission, please visit the Human Rights Commission webpage:  https://humboldtgov.org/1308/Human-Rights-Commission

   Please note that your application is subject to the California Public Records Act and disclosure requirements. 

4. First Name*
5. Last Name*
6. Preferred Pronoun
8. Address 1*
10. Address 2*
12. City*
13. State*
14. Zip*
16. Email*
18. Telephone (Home/Cell)*
19. Telephone (Work)
20. Fax
22. Occupation*

    Please list your current occupation and employer.

24. Personal References*

    Please list two references who can speak to your qualifications and ability to serve on the Human Rights Commission. Include their name, title/affiliated organization, their relationship to you, their phone number and email address.

26. Prior Advisory Board or Board of Directors Experience*
    -- Select One --YesNo

    Select one.

27. Resume*

    Please upload a current resume.

29. Why are you interested in serving on the Human Rights Commission?*

    Please write a brief statement describing why you are interested in serving on this commission.

31. Acknowledgement*

    1. Confirm

    By checking this box and submitting this application, I declare under penalty of perjury under laws of the State of California that the above is true and correct.

33. Type or Sign Your Name*
34. Date*

    Applications will be kept on file for two years.

Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field