Attachment 3 – Appointment Timeline & Sample Document
Contents
1. Sample Appointment Timeline
2. Draft Application
3. Sample Economic Interest Disclosure Form
Draft Appointment Timeline
2024 Council Appointment Process
Proposed Dates Action Notes
3/1/2024 – 3/15/2024 Application Period Application period per CVMC
2.53 3/15/2024 by 11:59pm Completed applications due
3/26/2024 or other
meeting date(s) set by City
Council
Councilmembers to provide
nominees for interviews
City Clerk will deliver
applications to City Council
and public no later than 72
hours before the meeting
3/28/2024 by 11:59pm Nominees submit Economic
Disclosure form
If required by City Council
4/9/2024 or other meeting
date(s) set by City Council
Candidate Interviews City Clerk will publish the list
of final nominee names and full
application packets no later
than 72 hours before the
meeting.
(Additional City Council meetings may be required to continue interviews and/or deliberations.) 4/11/2024 Deadline to make an
appointment
If Council, by majority vote,
does not make an appointment
during the 45-day time period,
the City Co uncil’s power to
appoint is terminated and the
seat will remain vacant for the
remainder of the term.
(Charter Sec. 303(C)(1))
Please keep this page 1 2 / 2 0 22
APPLICATION FOR DISTRICT 4 CITY COUNCILMEMBER
COVER PAGE – PLEASE KEEP THIS PAGE
Deadline: Friday, March 15, 2024
Instructions: All application questions must be answered and the required application components identified below must be submitted during the application period to be considered.
Application Deadline: Friday, March 15, 2024, by 11:59 p.m. for electronically submitted applications or by 5:00 p.m. if personally delivered to the City Clerk’s Office. If submitted by mail, the completed application, résumé, and biography must be postmarked by March 15, 2024 , and received no later than March 20, 2024.
Late or incomplete applications will not be accepted.
Required Components:
A “qualified application” is an application received within the application period with all of the following required components:
1. Completed application
2. Résumé – maximum of two pages in length
3. Biography – one page in length
Application Submittal: Online at www.chulavistaca.gov/d4application, or personally delivered or returned by mail to: Chula Vista City Hall, Attn: City Clerk, 276 Fourth Avenue, Chula Vista, CA 91910.
District 4 City Council Boundaries: The District 4 boundaries that were adopted by the City Council in 2015 will apply to fill this vacancy. Please use the interactive map at www.chulavistaca.gov/d4application to look up your home address. The applicable District 4 map is shown below.
QUESTIONS? Contact us at [email protected] or (619) 691-5041
Please Note: This application, including attachments, may be subject to the California Public Records Act and, therefore, may be publicly disclosed unless otherwise exempt.
APPLICATION FOR DISTRICT 4 CITY COUNCILMEMBER
Please read all instructions, submittal requirements, and deadline information on the cover page.
All questions must be answered. If a question does not apply to you, write “N/A” in the space provided.
Any application received after the application deadline will be disqualified from consideration. Any application received that is incomplete or missing required components will also be disqualified unless cured prior to the application deadline.
1. First and Last Name: (☐Mr. ☐Ms. ☐Mrs. ☐Mx. ☐Other: ____) ________________________________________________________
2. E-mail: ___________________________________________________________ Phone: _______________________________________
3. Home Address: ________________________________________________________ City: ____________________________________ Zip: __________
4. Do you live within the City of Chula Vista District 4 boundaries, as adopted by the City Council in 2015? Interactive map available at www.chulavistaca.gov/d4application ☐Yes ☐No If yes, how long? ____________ I confirm I am a registered voter in the District 4 boundaries specified above.
Initials
5. Present Employer: _____________________________________________________ Occupation: ___________________________________________
6. Relevant Educational Background:
_________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________
7. Are you currently serving on any board or commission for the City or any other governmental agency? If appointed to City Council, you must resign from your current City board or commission position. ☐Yes ☐No If yes, which one(s)? _______________________________________________________________________________________
8. Have you previously served on the City Council or any board or commission for the City or any other governmental agency?
☐Yes ☐No If yes, which one(s)? __________________________________________ Dates Served: _____________
9. Please list any local, civic, or community groups you have been involved with:
_________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________
10. What experience or special knowledge could you bring to this position? _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________
Please Note: This application, including attachments, may be subject to the California Public Records Act and, therefore, may be publicly disclosed unless otherwise exempt.
11. What would you hope to accomplish as a Councilmember? _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ Acknowledgments
Please initial the lines below to acknowledge each statement:
_____ I understand that, if appointed, I will NOT be eligible to seek election to District 4 City Councilmember in the City of Chula Vista for a period of one year following the termination of my appointed term. City Charter Section 300(E)
_____ I understand that, if I am selected as a finalist, I will be required to complete an Economic Interests Disclosure form, on which I must disclose all economic interests that I have within the boundaries of the City of Chula Vista in the categories of investments, income, gifts, and real property. _____ I understand that I must submit a completed application, résumé (maximum of two pages), and a biography (one page) by the application deadline and that late applications and those missing required components will be disqualified. I understand the application deadline is Friday, March 15, by 11:59 p.m. for electronically submitted applications or by 5:00 p.m. if personally delivered to the City Clerk’s Office. If submitted by mail, the application must be postmarked by March 15, 2024, and received by the Office of the City Clerk no later than March 20, 2024. _____ I understand that this application and any documents submitted in connection with the application process are public records and will be publicly disclosed unless otherwise exempt. Email addresses and phone numbers will be redacted.
_____ I understand that my application will not be considered if I am determined to be disqualified from holding office pursuant to Government Code section 1021, Chula Vista Charter Section 903, or any other applicable local, state, or federal law.
I hereby certify under penalty of perjury under the l aws of the State of California that the information I have provided in this application is true and correct, and that I meet the qualifications of this office as established by the Chula Vista Charter and other applicable statutory or constitutional laws.
Signature: ________________________________________________________________________ Date: ____________________________________________ Official Use Only
Clerk District Lookup By Résumé Received
ROV Verif Date By Biography Received
Name: ______________________________________
Email: ______________________________________
1 | P a g e 1 2 / 2 0 22
ECONOMIC INTERESTS DISCLOSURE
In order to determine potential conflicts of interest, please disclose all economic interests that you have had within the boundaries of the City of Chula Vista under the following categories (if you have nothing to disclose, indicate with “N/A”). Attach additional pages as needed.
INVESTMENTS
Disclose any financial interests with a value greater than $2,000 that you, your spouse, registered domestic partner, or dependent children had with any business located, doing business, planning to do business, or that has done business in the past two ye ars, in the City of Chula Vista (include stocks, bonds, sole proprietorships, partnerships, trusts).
BUSINESS NAME ESTIMATED VALUE GROSS ANNUAL INCOME
☐ $0-1,999 ☐ $2,000-$10,000
☐ $10,001-$100,000 ☐ $100,001-$1,000,000
☐ Over $1,000,000
☐ $0-499 ☐ $500-$1,000
☐ $1,001-$10,000 ☐ $10,001-$100,000
☐ Over $100,000
☐ $0-1,999 ☐ $2,000-$10,000
☐ $10,001-$100,000 ☐ $100,001-$1,000,000
☐ Over $1,000,000
☐ $0-499 ☐ $500-$1,000
☐ $1,001-$10,000 ☐ $10,001-$100,000
☐ Over $100,000
☐ $0-1,999 ☐ $2,000-$10,000
☐ $10,001-$100,000 ☐ $100,001-$1,000,000
☐ Over $1,000,000
☐ $0-499 ☐ $500-$1,000
☐ $1,001-$10,000 ☐ $10,001-$100,000
☐ Over $100,000
Attach additional pages as needed.
INCOME
Disclose the source and amount of gross income or loan of $500 or more that was received by you, your spouse, or your registered domestic partner during the past year from any source located, doing business, planning to do business, or that has done busine ss in the past two years, in the City of Chula Vista. (You are not required to report loans from commercial lending institutes, child support or alimony payments, or salaries, reimbursements for expenses, social security, disability, or other similar benefit payments from a federal, state, or local government agency.)
SOURCE OF INCOME YOUR BUSINESS
POSITION
GROSS ANNUAL INCOME OR LOAN
AMOUNT
☐ $500-$1,000 ☐ $1,001-$10,000
☐ $10,001-$100,000 ☐ Over $100,000
☐ $500-$1,000 ☐ $1,001-$10,000
☐ $10,001-$100,000 ☐ Over $100,000
☐ $500-$1,000 ☐ $1,001-$10,000
☐ $10,001-$100,000 ☐ Over $100,000
☐ $500-$1,000 ☐ $1,001-$10,000
☐ $10,001-$100,000 ☐ Over $100,000
Attach additional pages as needed.
Name: ______________________________________
2 | P a g e – E c o n o m i c I n t e r e s t s D i s c l o s u r e 0 1 / 2 0 2 3
GIFTS
Disclose the source, description, and value of gift(s) valued at $50 or more from a single source during the past year from any source located, doing business, planning to do business, or that has done business in the past two years, in the City of Chula Vista. A gift is anything of value for which you have not provided equal or greater consideration to the donor. (You are not required to disclose gifts from family members, inheritances, or campaign contributions.)
NAME OF SOURCE DESCRIPTION OF GIFT VALUE
Attach additional pages as needed.
REAL PROPERTY
Disclose interests that you, your spouse, registered domestic partner, or your dependent children had of $2,000 or more during the past year in real property located in the City of Chula Vista or within two miles of the boundaries of the City of Chula Vista. (You are not required to disclose property used exclusively as a personal residence.)
CITY WHERE
PROPERTY IS
LOCATED
FAIR MARKET VALUE GROSS ANNUAL INCOME
(IF RENTAL)
☐ $2,000-$10,000 ☐ $10,001-$100,000
☐ $100,001-$1,000,000 ☐ Over $1,000,000
☐ $0-499 ☐ $500-$1,000
☐ $1,001-$10,000 ☐ $10,001-$100,000
☐ Over $100,000
☐ $2,000-$10,000 ☐ $10,001-$100,000
☐ $100,001-$1,000,000 ☐ Over $1,000,000
☐ $0-499 ☐ $500-$1,000
☐ $1,001-$10,000 ☐ $10,001-$100,000
☐ Over $100,000
☐ $2,000-$10,000 ☐ $10,001-$100,000
☐ $100,001-$1,000,000 ☐ Over $1,000,000
☐ $0-499 ☐ $500-$1,000
☐ $1,001-$10,000 ☐ $10,001-$100,000
☐ Over $100,000
Attach additional pages as needed.
I hereby certify under penalty of perjury under the laws of the State of California that the information I have provided in this application is true and correct.
Signature _________________________________________________ Date ________________________