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Application for membership on the Privacy Protection and Technology Advisory Commission 

1

Prefix

Prefix

Mr.

Mrs.

Ms.

Mx.

Dr.

I'll fill it in myself If other, type text here.

N/A

2

Preferred Pronoun

Preferred Pronoun

He/Him/His

She/Her/Hers

They/Them/Theirs

Ze/Hir/Hirs

Ey/Em/Eirs

I'll fill it in myself If other, type text here.

3

First and Last Name

 *

First and Last Name

4

Email

 *

Email

5

Home Address

 *

Home Address

6

City

City

7

ZIP Code

 *

ZIP Code

8

Primary Phone

 *

Primary Phone ext.

9

Secondary Phone

Secondary Phone ext.

10

I certify that I am 18 years of age and the following statement applies to me:

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I certify that I am 18 years of age and the following statement applies to me:

I am a resident of the City of Chula Vista

I am NOT a resident of the City of Chula Vista but I own and/or operate a business and/or property with a physical address in the City of Chula Vista

11

If you own and/or operate a business and/or property with a physical address in the City of Chula Vista, list the physical address of the business or property; if this does not apply to you, please write not applicable. 

 *

If you own and/or operate a business and/or property with a physical address in the City of Chula Vista, list the physical address of the business or property; if this does not apply to you, please write not applicable.

12

How long have you been a resident and/or owned and operated a business and/or property in the City of Chula Vista? 

How long have you been a resident and/or owned and operated a business and/or property in the City of Chula Vista?

13

I am a resident and/or own and operate a business and/or property in the following City Council district. Please click here to view the interactive map and verify your District of residency

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I am a resident and/or own and operate a business and/or property in the following City Council district. Please click here to view the interactive map and verify your District of residency

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2

3

4

14

Present employer

 *

Present employer

15

Position

 *

Position

16

Have you ever been employed by the City of Chula Vista?

 *

Have you ever been employed by the City of Chula Vista?

Yes

No

17

If you have worked for the City of Chula Vista please provide the department and dates of employment. 

If you have worked for the City of Chula Vista please provide the department and dates of employment.

18

Please indicate the area(s) in which you have expertise and experience, or select None: (select as many as applicable)

 *

Please indicate the area(s) in which you have expertise and experience, or select None: (select as many as applicable)

Information Technology & Data Security - Experience and/or expertise in cyber security and sensitive personal information management and protection.

Privacy Protection - Experience and/or academic or legal background related to individual privacy protection, open government principles and structures, and/or government transparency.

Accounting and Finance - Experience and/or professional credentials in contracting, procurement, public auditing, control, compliance, and/or general oversight professional services.

Public Safety - Experience and/or expertise in federal, state, or local government public safety functions and operations.

Equity and Civil Rights - Experience or legal background in the advocacy for marginalized groups and communities who have traditionally experienced privacy and civil rights concerns based on sex, gender, disability, socio-economic profile, national origin, culture, or ethnic background.

None of the above

19

If you selected one or more of the areas of expertise and experience above, please describe the expertise and experience that you would bring to the selected area(s). (250 words or less)

 *

If you selected one or more of the areas of expertise and experience above, please describe the expertise and experience that you would bring to the selected area(s). (250 words or less)

20

Are you currently serving on any board or commission for Chula Vista or any other governmental agency?

 *

Are you currently serving on any board or commission for Chula Vista or any other governmental agency?

Yes

No

21

If so, which ones?

If so, which ones?

22

Per Chula Vista Municipal Code Section 2.25.030, I understand:

-If I am currently serving on a board or commission, I must resign from my current board or commission if I am appointed.

-I must have served at least 12 months on my current board or commission in order to be appointed to another board or commission.

 *

I have read and acknowledge the above statements. (please initial)

23

What do you hope to accomplish in the role of a Privacy Protection & Technology Advisory Commissioner? (250 words or less)

 

 *

What do you hope to accomplish in the role of a Privacy Protection & Technology Advisory Commissioner? (250 words or less)

24

I understand that to be considered, I must submit a résumé  along with this application.

 *

I understand that to be considered, I must submit a résumé along with this application.

Please initial

I understand that to be considered, I must submit a résumé along with this application. Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

Acknowledgments

25

The City understands meeting schedules and individual availability may change. We ask that you consider the meeting schedule when applying. In accordance with CVMC 2.25.200, the Commission shall set the date, time, and location of its regular meetings by written resolution and may change its regular meeting day, time, or location by written resolution. The Commission’s meeting schedule shall include at least one regular meeting every other month through December 31, 2024, and then one regular meeting quarterly thereafter. Special meetings may be scheduled as needed. Ordinance No. 3553 

 *

Enter your initials to acknowledge the statement above.

26

I am familiar with the responsibilities of the Privacy Protection and Technology Advisory Commission and I am willing to assume them. 

 *

Enter your initials to acknowledge the statement above.

27

I understand if I am selected to serve on this board or commission I will need to disclose certain economic interests on a public document (Form 700) in accordance with the City of Chula Vista's Conflict of Interest Code 

 *

Enter your initials to acknowledge the statement above.

28

I understand that this application and any documents submitted in connection with the application process are public records and may be publicly disclosed.    

 *

Enter your initials to acknowledge the statement above.

29

I attest the information I provided is accurate and true.

 *

Enter your full name to acknowledge the attestation above.

30

Where did you hear about this vacancy?

Where did you hear about this vacancy?

City’s Social Media

Chula Vista Library

City’s Website

City Employee

City Board/Commission Member or Staff

Other (please enter text below) If other, type text here.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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