BCC Application 2022

I am applying for: *

Architectural Advisory Committee (appointed by the Planning Commission)

If there were to be an opening for other Boards, Commissions or Committees other than the appointment that you are seeking, which Board, Commission or Committee would you be interested in serving on? (This is for City Council information only and does not guarantee appointment to a BCC)

Full Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Alternate Phone Number

E-mail *

example@example.com

Are you currently serving on a Board, Committee or Commission? *

Yes No

Are you a resident of incorporated Redwood City? *

Yes No

What district do you live in? *

District lookup tool: https://www.redwoodcity.org/departments/city-clerk/redistricting-process

Per Section 21 1/2 of the City Charter, most BCC Members must be residents and electors of the City. This means you must: 1) Be age 18 or older 2) Live within incorporated Redwood City (Note that there are exceptions to the residency requirement for the Housing and Human Concerns Committee, Architectural Advisory Committee, Historic Resources Advisory Committee, Transportation Advisory Committee and Police Advisory Committee); and 3) Be eligible to vote. Do you meet these requirements? *

Yes No

How long have you been part of the Redwood City community? *

Are you related to a current Council Member? *

Yes No

Occupation:

Employer's name:

Employer's address:

Length of employment:

How many Redwood City Board, Committee or Commission meetings have you attended in the past year? *

How many Redwood City Council meetings have you attended in the past year? *

How did you hear about this recruitment? *

City website Social media Neighborhood newsletter Newspaper Friend Banner Other

Are you applying for re-appointment? *

Yes No

Please list any community organizations to which you belong or community activities in which you have participated: *

Please provide a brief description of why you are seeking this appointment: *

What do you see as the key issue(s) facing the Board, Committee or Commission you have selected? *

What unique strengths, abilities or experiences do you have and how would these help further the work of the specific Board, Committee or Commission you are applying for? *

What communities do you believe you represent? *

Gender

Man Woman Non-Binary Prefer not to say Other

Age

Under 18 18 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65-74 75+ Prefer not to say

American Indian / Alaska Native Asian African American / Black Caucasian / White Hispanic / LatinX Pacific Islander Southwest Asian / North African Prefer not to say If other, enter here

Resume / Work Product File Upload

Attach resume here (optional)

ACKNOWLEDGMENT OF RESPONSIBILITIES

The Political Reform Act of 1974 requires all government agencies to adopt a Conflict of Interest Code which designates the positions within an agency which make or participate in making governmental decisions which may foreseeably have a material effect on any financial interest. Members of Redwood City Boards, Committees and Commissions, by virtue of their positions, make or participate in making decisions which may affect their financial interests and who therefore must disclose these interests on the Fair Political Practices Commission Form 700 – Statement of Economic Interests of Designated Employees. The Form 700 is a public document and its contents will be disclosed upon request. This form is to be filed every year with the Office of the City Clerk on April 1.

Appointed Boards, Commission and Committee members are required to complete a 2-hour free Ethics training every two years.

I understand that this application is a public document and its contents will be disclosed upon request, and any misrepresentation or deliberate omission of a material fact in this application may be justification for refusal or termination of appointment. I also authorize persons knowledgeable of the information stated herein to give any additional information regarding my qualifications and character. I hereby release said persons from any liability for any damages whatsoever for issuing this information.

Please confirm that you acknowledge the above responsibilities and understand that your application is a public document and may be disclosed upon request. *

Yes, I understand that I must file the FPPC Form 700 within 30 days of assuming office, as well as annually on April 1. Yes, I understand that I must complete the required 2-hour Ethics training every two years. Yes, I understand that my application is a public document and may be disclosed upon request, and authorize persons knowledgeable of the information stated herein to give any additional information regarding my qualifications and character, and also release said persons from any liability for any damages whatsoever for issuing this information.

2022 Application for Council Appointment to City Boards, Commissions & Committees

Employment Information

Serving on the Board / Committee / Commission

Demographic Survey

Race / Ethnicity (select all that apply)

Resume / work product upload (optional):