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APPLICANT QUESTIONNAIRE FOR FOR COMMISSIONS AND BOARDS 10890 San Pablo Avenue El Cerrito, CA 94530 Name: Address: City/State/Zip: Length of residence: At above address: In El Cerrito: In Contra Costa County: Check one: Own home Rent home Other Home Phone: Business Phone: E-Mail address: Indicate your preference (please rank up to three choices): Arts and Culture Commission—meets 3rd Wednesday each month, 7:00 p.m. Civil Service Commission—meets as required CCC Library Commission—meets every other month @ Pleasant Hill, 7:00 p.m. Citizens Bond Oversight Committee (CBOC) Committee on Aging–meets 3rd Wednesday each month, 3:00 p.m. Crime Prevention Committee–meets 2nd Wednesday each month, 7:00 p.m. Design Review Board—meets 3rd Wednesday each month, 7:30 p.m. Economic Development Board—meets quarterly, 6:30 p.m. Environmental Quality Committee Financial Advisory Board—meets 2nd Tuesday of each month, 7:00 p.m. Human Relations Commission—meets 1st Wednesday of even numbered months, 7:00 p.m. Park and Recreation Commission—meets 4th Wednesday of each month, 7:30 p.m. Planning Commission—meets 1st Wednesday of each month, 7:30 p.m. Street Repair and Maintenance Citizen’s Oversight Committee Tree Committee—meets as required EMPLOYMENT (please feel free to attach a resume) Occupation: Name and address of present employer (or last, if retired): REFERENCES Please list two personal or professional references, including name, address, and daytime telephone numbers: 1. 2. ---PAGE BREAK--- EDUCATION AND TRAINING: REASON(S) FOR APPLYING: EXPERIENCES AND ABILITIES Considering your previous experience and activities in business, labor, professional, social, or other organizations; indicate your most important experiences and abilities, which qualify you for the appointment: PREVIOUS EXPERIENCE If you have had public service experience on a commission, board, or task force, please indicate the public agency and explain duties: CONFLICT OF INTEREST: Please describe any possible personal or professional areas that may present a conflict of interest, or the appearance of conflict of interest, for serving on this board, commission or committee: (You may attach additional sheets as necessary to respond.) To the El Cerrito City Council: I request that you consider my application. I am aware of the meeting schedule and feel that I will be able to devote the time necessary to perform the duties of this body. I am also aware that my name and address may be made public as an applicant for this body, and that this application is a public record, which will be held on file for subsequent vacancies. I am also aware that by law, interviews regarding my appointment, reappointment, or dismissal must be held in public and that the City Council cannot exercise any discretion in this matter. I am further aware that I may be required to file an annual Statement of Economic Interests and affirm the Oath of Office with the City Clerk. Please return to City Clerk at the above address. MEMBERS OF BOARDS, COMMISSIONS, AND COMMITTEES SHALL NOT HOLD ANY OTHER PUBLIC OFFICE OR POSITION IN THE CITY AND SHALL, AT ALL TIMES DURING THEIR SERVICE, BE RESIDENTS WITHIN THE CITY LIMITS OF EL CERRITO (unless specifically provided for in the El Cerrito Municipal Code). BOARD, COMMISSION AND COMMITTEE MEMBERS PLEDGE THE OATH OF OFFICE. THE FILING OF A FPPC FORM 700 – STATEMENT OF ECONOMIC INTERESTS IS REQUIRED FOR THE ARTS & CULTURE COMMISSION, DESIGN REVIEW BOARD, FINANCIAL ADVISORY BOARD, and PLANNING COMMISSION.