Application for membership on the Board of Ethics

1

Prefix

Prefix

Mr.

Mrs.

Ms.

Mx.

Dr.

Other: 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

Other: If other, type text here.

3

First and Last Name

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First and Last Name

4

E-mail

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E-mail

5

Home Address

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Home Address

6

City

City

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ZIP code

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ZIP code

8

Primary Phone

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Primary Phoneext.

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Secondary Phone

Secondary Phoneext.

10

I certify that I am a resident of the City of Chula Vista and at least 18 years of age

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I certify that I am a resident of the City of Chula Vista and at least 18 years of age (Select an Answer) Yes No

11

How long have you been a resident of the City?  

How long have you been a resident of the City?

12

Please click here to view the interactive map and verify your District of residency

I am a resident of the following City Council district.

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Please click here to view the interactive map and verify your District of residency I am a resident of the following City Council district. (Select an Answer) 1 2 3 4

13

Present employer

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Present employer

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Occupation

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Occupation

15

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

 

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

Yes

No

16

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.

17

Are you currently serving on a Chula Vista Board/Commission?

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Are you currently serving on a Chula Vista Board/Commission?

Yes

No

18

Which one(s)?

Which one(s)?

19

Have you previously served on a Chula Vista Board/Commission?

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Have you previously served on a Chula Vista Board/Commission?

Yes

No

20

Which ones?

Which ones?

21

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.

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I have read and acknowledged the above statement.

22

Are you or have you been involved in any local, civic or community groups?

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Are you or have you been involved in any local, civic or community groups?

Yes

No

23

Which ones?

Which ones?

24

What are your principal areas of interest in our City government, and what experience or special knowledge can you bring to those areas?

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What are your principal areas of interest in our City government, and what experience or special knowledge can you bring to those areas?

25

What would you hope to accomplish in the role of a Member of the Board of Ethics? (250 words or less)

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What would you hope to accomplish in the role of a Member of the Board of Ethics? (250 words or less)

26

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

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I understand that to be considered, I must submit a resume 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

27

Do you have any “conflicts of interest” as defined below?

As defined in Chula Vista Municipal Code 2.28.050, a “conflict of interest” means the following:

1. The applicant or any of applicant’s relatives is or has been an employee of or sought employment from any City official subject to this chapter;

2. The applicant or any of applicant’s relatives is or has been supervised in an employment setting by any City official subject to this chapter;

3. The applicant has served in any capacity (including staff member, advisor, or volunteer) involving the election, selection, or appointment of any City official subject to this chapter to any public office (elected or appointed);

4. The applicant has served in any capacity (including staff member, advisor, or volunteer) opposing the election, selection, or appointment of any City official subject to this chapter to any public office (elected or appointed); or

5. The applicant is related to any City official subject to this chapter.”

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Do you have any “conflicts of interest” as defined below? As defined in Chula Vista Municipal Code 2.28.050, a “conflict of interest” means the following: 1. The applicant or any of applicant’s relatives is or has been an employee of or sought employment from any City official subject to this chapter; 2. The applicant or any of applicant’s relatives is or has been supervised in an employment setting by any City official subject to this chapter; 3. The applicant has served in any capacity (including staff member, advisor, or volunteer) involving the election, selection, or appointment of any City official subject to this chapter to any public office (elected or appointed); 4. The applicant has served in any capacity (including staff member, advisor, or volunteer) opposing the election, selection, or appointment of any City official subject to this chapter to any public office (elected or appointed); or 5. The applicant is related to any City official subject to this chapter.”

Yes

No

28

Have you, within the past 10 years, been convicted of any felony or a crime involving moral turpitude or been found to have committed a criminal violation of the Fair Political Practices Act?

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Have you, within the past 10 years, been convicted of any felony or a crime involving moral turpitude or been found to have committed a criminal violation of the Fair Political Practices Act?

Yes

No

29

The City understands meeting schedules and individual's availability may change. We ask that you consider the meeting schedule when submitting an application.

I have reviewed the Board of Ethics regular meeting date, time and frequency.

30

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

I have reviewed the City of Chula Vista's Conflict of Interest Code.

31

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I am familiar with the responsibilities of the Board of Ethics. I attest that the information I have provided is accurate and true.

32

 

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

33

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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