Intranet: Labor Management Committee Membership Application

Health Care Agency
Labor Management Committee
Email: hcaocealmc@ochca.com
c/o Greg Manning, Co-Team Leader
800 N. Ekhoff
Orange, CA 92688
Phone: 714-490-3932
Fax 714-940-3916
Pony: HCA/CYS/LMC Bldg 135-B

c/o Elizabeth Bausman, Co-Team Leader
550 N. Flower
Santa Ana, CA 92703
Phone: 714-647-4673
Fax 714-647-7496
Pony: HCA/CMH/LMC Bldg 96-CMH

Committee Membership Application
The Labor Management Committee

You may fill out the form below and submit it online or print out a Word version and return to:

Regular Mail:
HCA LMC Recruitment Subcommittee
c/o Rhena Carusillo
405 W. 5th Street, Suite 300,
714-796-0235

E-mail: hcaocealmc@ochca.com
Fax: 714-834-3492
Pony mail: Bldg. #38-300

about downloading files

For Online submission, complete the following information:

Name	Work Telephone
E-Mail address (replace example with your own)
Service Areass (check one) Administration Behavioral Health Medical & Institutional Health Public Health Regulatory Health
Job Title
Program/Divison	Work Schedule (e.g., 9/40 flex Friday)
Work location address	Pony Mail
Supervisor Name
Initial Hire Date (month/year)	Fax Number
Prior or current participation in OCEA activities
Prior or current participation in Agency/Division activities
Explain why you are interested in becoming an OCEA representative on the Labor Management Committee
I am an OCEA member and I wish to participate in the Health Care Agency Labor Management Committee. I have been advised that the committee meets once a month and that Committee membership obligations will require a time commitment of 5 - 10 hours per month. I acknowledge and agree to the significant commitment of time and effort required on my part, and I agree as a condition to my participation that I will perform everything required of Committee employee representatives, including attending meetings, conducting research, and fact gathering, and communicating Committee activities to other employees. Date