Form Center

3. 
6. PUEBLO HUMAN RELATIONS COMMISSION
   Application for Appointment
   
   The Pueblo Human Relations Commission is committed to promoting mutual understanding
   and respect for all citizens and promoting open dialogue for all to participate.
8. Contact Information
10. DATE
    DATE
12. FIRST NAME
13. Middle Initial
14. LAST NAME
16. HOME ADDRESS
18. CITY
19. STATE
20. ZIP
22. HOME PHONE
23. WORK PHONE
24. CELL PHONE
26. E-MAIL ADDRESS
28. ARE YOU CURRENTLY EMPLOYED WITH THE CITY OF PUEBLO?

    1. Yes
    2. No
29. ARE YOU A RESIDENT OF THE CITY OF PUEBLO?

    1. YES
    2. NO
31. OCCUPATION (or if RETIRED, your previous occupation)
33. EDUCATION
35. Group Representation
37. Please check the category or categories that best describes your qualifications or interest:

    1. Religious
    2. Racial

    1. Gender
    2. Sexual Orientation

    1. Disabled
    2. Ethic

    1. Generational
39. Questionnaire
    Please complete the following general information.
41. Please elaborate on your qualifications for or interest in the category or categories you selected above.
43. Why do you want to serve on the Human Relations Commission?
45. How much time are you willing to devote to fulfill the obligations as a Human Relations Commission Member?
47. What special accommodations, if any, will you need as a Commission Member?
    (Translator, Signer, Transportation, etc.)
49. What abilities and skills do you have which can be used as a resource to the Human Relations Commission?
    Bi-lingual? Signing? Other?
51. What are the three most important issues that you feel this Commission can play a role in addressing?
53. What do you feel are Pueblo’s strengths?
55. What do you feel are Pueblo’s greatest challenges?
59. Upload resume, references and/or other pertinent information
Leave This Blank:


60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit Submit and Print

* indicates a required field