APPLICATION FOR COUNCIL APPOINTMENT TO ADVISORY BODY
Revised 10/2023
This application is considered a public record pursuant to The California Public Records Act (Government Code 6520 et seq.) and may be made available to any member of the public upon request. Appointee’s contact information may be published in the City of Cotati public informational roster.
Appointees to certain advisory bodies will be required to complete a Statement of Economic Interest as required by California Government Code §87200 et seq. and the City of Cotati Conflict of Interest Code.
Advisory body to which appointment is sought:
Planning Commission Measure S Oversight Committee
Other
CONTACT INFORMATION
First Name: Last Name:
Mailing
Address:
E-mail:
Phone:
Alt phone:
EDUCATION
High School Graduate; or Location: GED
College/University Major Degree/Date
Other formal education:
______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Choose one; please complete a separate application for each advisory body for which you would like to be considered. Marin/Sonoma Mosquito & Vector Control District
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SF State Univ Bachelors Degree Business Adm Skyline College Carmen Garcia 8810 Clothier Ln Cotati CA 94931 [email protected] 707-921-9248 ✔ Application for appointment to advisory body
EMPLOYMENT HISTORY
List all employment during the last five years. If retired, list last employer.
Period Employer (include location) Position/Title
PERSONAL INFORMATION
Year you became a Cotati resident: _____________________ Are you a City of Cotati registered voter? Yes No
Are you related to any member of the City Council, any City advisory body Member or City Employee? If yes, please list name and relationship:
Yes No
Are you currently a vendor or contractor with the City of Cotati Yes No Are you currently employed by the City of Cotati? Yes No Have you ever been convicted of a felony? If yes, please explain: Yes No List civic activities, clubs, associations, etc.:
______________________________________________________________________________________ ______________________________________________________________________________________ Briefly state your reasons for interest in the appointment sought:
______________________________________________________________________________________ ______________________________________________________________________________________ Please initial the following 2 paragraphs:
_________ I understand that this application is considered a public record pursuant to The California Public Records Act (Government Code 6520 et seq.) and may be made available to any member of the public upon request. Appointee’s contact information may be published in the City of Cotati public informational roster. _________ I understand that appointees to certain advisory bodies will be required to complete a Statement of Economic Interest as required by California Government Code §87200 et seq. and the City of Cotati Conflict of Interest Code.
I certify that the foregoing is true and correct to the best of my knowledge:
______________________________________ __________________________ Signature Date Emergency contact information (confidential; for emergency use only):
_________________________________ Name
___________________________ _______________
Relationship Phone number
Thank you for your interest. Please return completed form to the 'HSXW\City Clerk via email at NHSDWWHUVRQ#FRWDWLFLW\RUg or deliever to City of Cotati, Attn.: Deputy City Clerk, 201 West Sierra Avenue, Cotati, CA 94931-4217
Y:\PROCEDURES SOPS\CMO Procdures SOPs\CITY CLERK PROCEDURES MANUAL\18.Advisory Bodies (City Commissions and Committees)\ADVISORY BODIES (Boards-Commissions etc.)\Application for Appointment to Advisory Body.docx 11/2005 to 5/2023 Exchange Bank Vice President/Manager 1989 Hispanic Chamber of Commerce Sonoma County, Roseland University Prep - Advisory Bo Board, CAPS- Community Action Partnership of Sonoma CG 10/23/2023 Ben Garcia Husband CG ✔
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707-758-3027