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M.I.

*Last Name

Nickname

RESIDENTIAL ADDRESS

*Street

*City

*Zip

Home Phone ( ) -

Are you a registered voter in Orange County?
Note: If you are registered to vote in California, you can work the polls. You do NOT need to be registered in Orange County.

yes      no

*Department Choose one... Assessor's Office Auditor Controller Office Board of Supervisors Child Support Services Clerk of the Board Community Services Agency County Clerk/Recorder County Counsel County Executive Office District Attorney DPHD Health Care Agency Housing & Community Development Integrated Waste Management Internal Audit Division John Wayne Airport L.A.F.CO. Orange County Law Library OC Public Library Planning & Development Probation Public Defender RDMD Registrar of Voters Retirement Sheriff's Social Services Agency State Employee Superior Court Treasurer Public Admin/Public Guard

* Work Phone ( ) -
*Work E-Mail Address

Supervisor Information
*Supervisor's name
*Supervisor's work phone ( ) -

*Supervisor's email
(note: The e-mail must be correct for the application to be processed)

What would you prefer to serve as? (click on the title to learn about job responsibility)

Clerk

A-Team

Inspector

*I am available to serve on:

June 8 , 2010 November 2, 2010

In addition to English, are you bilingual in...

Spanish      Vietnamese      Korean     
Mandarin      Taiwanese      Cantonese     

Comments (e.g. If out of county, what city do you prefer to be placed in):