2. 
4. PERSONAL INFORMATION

   Please provide your name, residency and contact information.

6. First Name:*
7. Last Name:*
9. Address:*
11. City:*
12. State*
13. Zip*
15. Length of Residence
17. Years at above address:*
18. Years in El Cerrito:
19. Years in Contra Costa County:
21. Owner/Tenant:

    1. Own home

    1. Rent home

    1. Other
23. Phone Number*
24. Alternate Phone #
25. Email Address*
27. CITY BOARDS, COMMISSIONS, AND COMMITTEES
    City Advisory Bodies Website

    Please visit the link above for more information and meeting schedules for each advisory bodies. 

    Applicants are required to attend two of the last three meetings of the advisory body applied for prior to submitting an application of interest to the City Clerk. Advisory Bodies that are exempt from this requirement can be selected from the second list below. (the above requirement has been suspended by City Council until 6/30/2023)
    
    Applicants are strongly encouraged to attend meetings of the advisory body applied for prior to submitting an application.

29. Advisory Body (pre-meeting attendance requirement is suspended)
    -- Select One --Arts & Culture CommissionCommittee on AgingCrime Prevention CommitteeDesign Review BoardEconomic Development CommitteeEnvironmental Quality CommitteeFinancial Advisory BoardHuman Relations CommissionPark and Recreation CommissionPlanning CommissionUrban Forest Committee

    Please click on the drop down menu above to select an advisory body group of your choice:

30. Meeting #1 Attended
    Meeting #1 Attended
31. Meeting # 2 Attended
    Meeting # 2 Attended
33. Advisory Body (pre-meeting attendance not required)
    -- Select One --CCC Advisory Council on Aging CCC Library CommissionCCC Mosquito and Vector Control District Board of TrusteesCC Transportation Authority Citizens Advisory CommitteeCitizens Street Repair and Maintenance Oversight CommitteeCivil Service Commission

    Please click on the drop down menu above to select an advisory body group of your choice:

    
    

35. Reason(s) for applying:
37. EMPLOYMENT
    Please provide current employer and occupation. Resumes are welcome but not required.
39. Name and address of current employer (or last, if retired):
41. Occupation:
42. Resume
44. EDUCATION AND EXPERIENCE:
    Share your education and experience, considering your activities in business, labor, professional, social, or other organizations; indicate relevant experience and abilities, including; and any prior experience with public agency boards, commissions, committees, taskforces, etc. which would help qualify you for appointment.
46. Education and Training:
48. Experience and Abilities:
50. Prior Experience with Advisory Bodies:
52. REFERENCES
    Please list two personal or professional references, including name, address, and contact information.
54. Reference 1:
56. Reference 2:
58. CONFLICTS 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 the board, commission or committee applied for.

60. Conflicts of Interest:
64. ACKNOWLEDGEMENTS
    Please read and acknowledge the following statements regarding requirements to serve.
66. I confirm that:

    1) The information submitted in this application is true and correct to the best of my knowledge;
    2) I do not hold any other public office or position in the City;
    3) I am a resident of El Cerrito and understand I must remain a resident for the duration of my service (unless otherwise provided in the Municipal Code); and
    4) I am aware of the meeting schedule for advisory body I am applying for and feel I will be able to devote the time necessary to perform the duties.

68. By checking this box:*

    1. I confirm the statement above
70. Within 30 days of appointment (unless otherwise indicated below), I understand that I am required to:

    1) File an OATH OF OFFICE (prior to the first meeting as a member);
    2) Complete two hours of Ethics Training;
    3) Complete one hour of Sexual Harassment Prevention Training;
    4) Complete Orientation/Handbook Training
    5) File a Statement of Economic Interests Form 700 if I am appointed to the ARTS AND CULTURE COMMISSION, DESIGN REVIEW BOARD, FINANCIAL ADVISORY BOARD or PLANNING COMMISSION; and
    6) Complete a criminal records background check prior to service on the CRIME PREVENTION COMMITTEE.

72. By checking this box:*

    1. I acknowledge the requirements above
74. By submitting my application I acknowledge and understand that:
    1)This application is a PUBLIC RECORD and will be disclosed in full upon request; and 2) Interviews regarding appointment, reappointment, or dismissal must be held in public and that the City Council cannot exercise any discretion in this matter.
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76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit Submit and Print

* indicates a required field