City of
San Bernardino CITY COUNCIL OFFICE
CITY OF SAN BERNARDING
BOARDS, COMMISSIONS, & CITIZEN ABYSORYH 2: 01 Date Received, For Official Use Only
COMMITTEES
BOARD(S), COMMISSIONS), AND/OR CHIZEN ADVISORY COMMITTEE(S APPLYING FOR:
1. Charter Committer 3.
2. LAST NAME FIRST NAME M.I.
O/son Scott
HOME ADDRESS ZIP PHONE
(HOME)
(MOBILB)
EMPLOYER JOB TITLE EMAIL ADDRESS
M/A
BUSINESS ADDRESS ZIP BUSINESS PHON
N/A NA
DATE OF BIRTH
Length of residence in the City of Are you a registered voter of the City Which ward do you reside in? San Bernardino of San Bernardino?
60 Years • Yes 0 0 0•0'
Months ONO 0006
Why you want to serve on a city board or commission:
It 15 time for me to give back fathe
City and Help Council wonen Sandra Ibarra
Board(s), Commission(s), & Citizen Advisory Committee(s) App. Page 1 of 3 Updated: August 29, 2018 What do you consider to be three (3) major assets that would qualify you for selection to this board, commission, or citizen advisory committee:
1. Long time involved res, dent
= Actively noolded in crty ssues 2o year
Desire to loank fouares positio
change in San Berdardino
Expenence or special knowledge pertaming to area(s) of mterest:
Comunitu Affairs Representative WVWD-membe
• Dozans of localstate, and Feleral Company s
Educational background:
Elementary Mitchell • Vely College Bes, dege.
High School: Paciti?.
California Eutheran College,
Occupational experience:
Comunity fairs Representative. WOW D
Professional or technical organization memberships:
test applecator and
Inspection Lisana Jermite soro
Board(s), Commission(s), & Citizen Advisory Committee(s) App. Page 2 of 3 Updated: August 29, 2018 Civc or community experence, memberships, or previous pubic service appomtments:
pirector pome of Merghtory serences, Ho Hoparade
County Bellion Committee, Alternate Central Committee
OPTIONAL
How would you classify yourself? (Optional)
•American Indian/Alaskan Native African American/Black • Asian •Hispanic/Latino •Native Hawaiian/Pacific Islander O White •Two or more of the above categories
What is your gender? (Optional)
• Female •other/Prefer to self describe
Male
Are you a person with a disability? (Optional)
• Yes ONO
Applications are screened on the basis of information submitted and may be subject to a Livescan as part of the application process.
The information provided is factual to the best of my knowledge. I understand that I may be required to complete a Statement of Economic Interests Form as required by law, and that I will abide by all the codes, ordinances, and regulations of the City of San Bernardino and the State of California.
Sett Olse 9-29-22
SIGNATURE DATE
Return to: The City of San Bernardino Council Office
Electronically: [email protected]
By Mail: 290 North D Street, San Bernardino, CA 92401
In Person: 290 North D Street, 1" Floor - City Information Center, San Bernardino, CA 92401
*Attach a resume and/or additional information which you feel will assist the Mayor and City Council in their selection.
Boards), Commission(s), & Citizen Advisory Committee(s) App. Page 3 of 3 Updated: August 29, 2018