Citizen Interest Form - City of Solana Beach

City's Conflict of Interest Code. •. I understand that 3 unexcused absences within 365 days are grounds for vacating my position. •. I am willing to attend/complete the required two hours of State mandated Ethics Training every two years. •. I am willing to complete the required Department of Justice background check.
341KB Sizes 3 Downloads 120 Views
City of Solana Beach CITIZEN INTEREST FORM Application for Citizen Commission Positions This document is a public document. To assist the City Council in evaluating each applicant in the selection of Commission Members, please provide as complete of a response as possible to all questions.

Name: _______________________________________ Phone Number: _______________ Residence Address: _________________________________________________________ Street

City

State

Zip Code

Mailing Address: (if different than above) ________________________________________ Street / P.O.Box

City

State

Zip Code

Email: ______________________________________________ business or personal to be used for commission communications

Employer: ___________________________________ Position: ______________________ Business Address: __________________________________________________________ Street

City

State

Zip Code

Business Phone: ________________________ Are you a resident of Solana Beach? ____ Yes

____ No

How long: _____

Do you own property in the City? ____ Yes ____ No If yes, please list the address(es) of the properties: ___________________________________________________________________________ Do you own or operate a business in Solana Beach? ____ Yes ____ No If yes, please state the name and nature of the business(es): ________________________ Member Commitment I am willing to fulfill all requirements of a Citizen Commission, including but not limited to:    

o o o

I am willing to file financial disclosure statements (Form 700), a public record, as required by the State and the City’s Conflict of Interest Code. I understand that 3 unexcused absences within 365 days are grounds for vacating my position. I am willing to attend/complete the required two hours of State mandated Ethics Training every two years. I am willing to complete the required Department of Justice background check.

Submit fully executed and signed hard copy (8 pgs min.) application to the City Clerk’s Office, City of Solana Beach, 635 S. Highway 101, Solana Beach, CA 92075. Email with a hard copy to follow is acceptable. Resumes will not be accepted in lieu of this application, only attached in addition to. Two recommendations must be completed by Solana Beach residents.

An original signature is required on all applications. I agree to all requirements mentioned above, per Solana Beach Municipal Code, and have provided all correct and truthful information in this application. ___________________________________

______________

Applicant signature

Date

Citizen Interest Form & Supplemental Questionnaire (Revised November 2016)

Page 1 of 8

COMMISSION APPLICATION CHOICE(S) Please indicate which of the five Citizen Commissions that you are interested in and answer the relative question(s). If you are willing to consider serving an alternative Commission to your primary preference, or an additional Commission, please indicate your preferences in order. Example: Indicate 1, 2, 3 for each Commission applying for in order of interest. ____ Budget and Finance Commission (Must be at least 18 years old, a city resident, and property owner within the City of Solana Beach)

What is your understanding of the duties as a member of the Budget & Finance Commission?

_______________________________________________________________________ _______________________________________________________________________ ____ Climate Action Commission – check one below ___ Resident (Must be at least 18 years old and a city resident) ___ Professional: From the environmental and/or scientific community (Resume/CurriculumVitae) Resident or Non-Resident

What is your understanding of the duties as a member of the Climate Action Commiss