Skip to Main Content
Do Not Show Again
I Want To...
Select a Category
Air Pollution Control
Americans with Disabilities Act (ADA)
Board of Supervisors
CEO - Tahoe
Child Support Services
Clerk of the Board
Community Development Resource Agency
Contact Placer County
County Executive Office
Health & Human Services - Adult System of Care
Health & Human Services - Animal Services
Health & Human Services - Children's System of Care
Health & Human Services - Environmental Health
Health & Human Services - General
Health & Human Services - Human Services
Health & Human Services - Public Health
OES - Office of Emergency Services
Stormwater Quality Management
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Home Phone Number
Cell Phone Number
Work Phone Number
Mailing Address (If Different)
Placer Employee Information
Employee Name / Description
Description of Event
Leave This Blank:
Receive an email copy of this form.
This field is not part of the form submission.
* indicates a required field
Slideshow Left Arrow
Slideshow Right Arrow