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City of Moreno Valley 24 MAR 11 PM T: 08
DECEMBER 3, V22 Boards and Commissions
Membership Application Form Stamp Bay me coined
Name: scano
Home Address: DISTRICT 1
MoreNo 7 CA 72553
How long have you resided in Moreno Valley? Ulyars
CONEIDENTIAL INFORMATION
Home Phone No Driver's License No.:
Attamatriork Phone No. Email Address:
Cell Phone No.: Date of Birth: 61761
Employer Name: NIA Position:
Address:
Board or Commission applying for: 19 Choice Sensor Citizens Board, Ar Commasion 2nd Choice Library Comnission
*If applying for the Accessibility Appeals Board, please indicate which position you are applying for:
Physically Challenged Person Person Experienced in Construction X Public Member *If applying for the Utilities Commission, please indicate which position you are applying for:
X Public Member Customer of Moreno Valley Utility Business Customer of Moreno Valley Utility *If applying for the MV Citizens Public Safety Committee, please indicate which position you are applying for: _ Business X Public Member
Why do you wish to serve on this Board and/or Commission? -Em recently retired an Mad ate eel it is my duty to over to overtee the questions
List any education, training, or special skills, you have which may be relevant or of particular benefit to his Board and/or Commission:
send in santon for 30t yers and hospital adriestraton
for more than 10 yeas.
Explain briefly your understanding of what this Board and/or Commission does, including its powers and pia Contine munapal quernment with legalities
executive authorit.
What do you hope to accomplish by your participation?
Commuching involvement. 1A5parancy.
List any employment, volunteer work, or membership in a service/community organization that you have served on, or are now a member of. Please provide the name(s) of the agency (ies), contact person, and dates served:
What other areas of interest do you have in our City government? alhat to heis the catens of mover bally, the ot Riverside and the State of Caleir to yphall the forks of its Stirs:
Would you be available for meetings during the day or evening? Attendance of at least one (1) meeting is required prior to appointment.
Date (s) of the meetings) attended: Mr 2 d
Pursuant to Resolution 2016-42 all board and commission members must be registered voters of the City of Moreno Valley.
I authorize the City of Moreno Valley to obtain and review, on a confidential basis, such information regarding me as may be contained in the California State Summary Criminal History and in records of the California Department of Motor Vehicles. Yes • No • (The application shall not be considered if the NO box is checked.)
I hereby agree to attend all board or commission meetings, unless excused, and understand that I may be removed for lack of attendance, pursuant to Municipal Code, Subsection 2.06.010(C) which states, "If a member is absent without advance permission of the board or commission or of the appointing authority, from three consecutive regular meetings or from 25% of the duly scheduled meetings of the board or commission within any fiscal year, the membership shall thereupon become vacant and shall be filled as any other vacancy."
CERTIFICATE OF APPLICANT: I certify that all statements in this application are true and complete to the best of my knowledge. I understand that any false statements of material fact will subiect me to disqualification or dismissal if appointed. I release the City of Moreno Valley from any liability for the use of the aforesaid information.
3-11-8024
Signature Date
Please Note: Applications will be kept on file for potential future vacancies for one year after the application submittal date. Applications are accepted year-round. All applications are public record; personal information may be redacted to protect applicants' privacy.
Revised June 15, 2020