COMMUNITY SERVICES, PARKS & RECREATION COMMISSION
APPLICATION
Thank you for your interest in serving on the Community Services, Parks & Recreation Commission! Your desire to participate in your community's activities is sincerely appreciated. Please complete this application and return it by email to [email protected] or by mail or in -person to City of Chino Office of the City Clerk, 13220 Central Avenue, Chino, CA 91710 by the published deadline. If you have any questions, please call the City Clerk's office at (909) 334-3306, or the Community Services, Parks & Recreation Department at (909) 334-3256.
THIS IS A PUBLIC DOCUMENT SUBJECT TO DISCLOSURE UNDER THE CALIFORNIA PUBLIC RECORDS ACT Name: __________________________________________ Email: ________________________________________ Home Address: _________________________________________________________________________________ Home/Cell Phone: ______________________________________________________________________________ Employer: _____________________________________ Position: ______________________________________ Business Address: __________________________________________ Business Phone: __________________ Education: _____________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Please tell us what you know about the Community Services, Parks & Recreation Department:
________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ List civic organizations you are affiliated with and/or volunteer experience:
________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Internal Use
Application Received: Date: By:
District: ☐ District 1 ☐ District 2 ☐ District 3 ☐ District 4 Li
st of the top five programs/services for youth, families, and adults, not currently offered, that you feel are needed:
________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ List of the top two issues facing Community Services, Parks & Recreation Department based on your observations:
________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Why do you want to be a Community Services, Parks & Recreation Commissioner? ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ I hereby certify that all statements made in this application are true and complete and any false or misleading statements made shall be grounds for immediate disqualification. I understand that if selected, satisfactory results from a background investiga tion are required. I reside in the City of Chino and I am aware Chino Municipal Code Section 2.38.030 requires residency at time of appointment and for the duration of the term. In compliance with State law, I understand that I will be required to file a Statement of Economic Interests upon appointment to office and annually thereafter. I understand that my application and materials will be considered a public record and thus will be available for public inspection and copying.
Signature: ______________________________________ Date: _______________