RECEIVED
City of
San Bernardino
AUG 1 3 2026
BOARDS, COMMISSIONS, & CITIZEN ADOX COUNCIL OFFICE...
COMMITTEES City of San Bemardino
ED
BOARD(S), COMMISSION(S), AND/OR CITIZEN ADVISORY COMMITTEE(S) APPLYING FOR:
1 ELECTED OFFICIAL COMAENSATIAN 3.
2. LAST NAME FIRST NAME M.I.
BAXTER J
HOME ADDRESS ZIP PHONE
(HoM:)
(MOBn.E)
EMPLOYER JOB TITLE EMAIL. ADDRESS
BUSINESS ADDRESS ZIP BUSINESS PHONE
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 Bemardino of San Bernardine?
12 Years X Yes 3 • › 7
3 Months ONo 4
Why you want to serve on a city board or commission:
ALWAYS INTERESTED N Bene ACTIVE IN
OUR CITY AND PARTICATE WHERE MAY
Board(s), Commission(s), & Citizan Advisory Committeds) 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. HAUR oVeR 40 VARRS oF MANAGEMENT
EXPRICENCE, SUPERVISING MARNAGGAS A HURLY
2. 3
A CONSENSUS oN compily 15SUR 5
Experience or special knowledge pertaining to areas) of interest:
IN THR DAIATE SACTOR WONIES IN COMEISATION
TENAS, iRANICUMO WAGES MAN CO MA-SATIO
PACKAGES.
Educational background:
BACHELOR EE BUSINESS ADMINSTrATION
Occupational experience:
VICE PRESIAGAT OF SURDRY CHREN (PRIUATE BUSBURGE
PurCHASING MANAGER FoR A CALIFOGNA CITI
Professional or technical organization memberships:
NONG AT THIS TIME
Boards). Commission(s), & Chizen Advisor Commitlee(s) App. Page 2 of3 Updated: August 29.2018 Civic or community experience, memberships, or previous public service appointments:
COMMISSIONER MRASURE S COMMITTEE (curreNT)
BOnRn MEMEn "WINDWOn PARI NEIGHBORHON ASSOGIATION
OPTIONAL
How would you classify yourself? (Optional)
American Indian/Alaskan Native African American/Black • Asian • Hispanic/Latino Native Hawaiian/Pacific Islander 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 NIK Bast 8-12-2026
SIGNATURE DATE
Return to: The City of San Bernardino Council Office
Electronically: Councilashcity.org
By Mail: 290 North D Street, San Bernardino, CA 92401
In Person: 290 North D Street, 1s' 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 Commitleds) App. Page 3 0f3 Updated: August 29.2018