Submit Date: May 18, 2022
First Name
Last Name
Email Address
Street Address
Suite or Apt
City
State
Postal Code
Primary Phone
Alternate Phone
Employer
Job Title
CITY OF SAN JOSE, CALIFORNIA
Boards and Commissions Application
Profile
Please note, applications are continuously accepted to the City of San Jose Boards and Commissions. The Board or Commission you select may or may not indicate there is a vacancy.
Your application will remain on file for one year from the date of submission. During the year, your application may be considered for unanticipated vacancies.
Which Boards would you like to apply for?
Board of Fair Campaign and Political Practices: Submitted Are you a resident of San Jose?
Yes
No
Length of Residency
6 or more years
What district do you live in? To verify, please click here: https://eservices.sccgov.org/rov/? tab=dt
*
District 5
Current Employer Address
Current Employer of Spouse
N/A
Baltazar
Lopez
San Jose
CA
95137
Congresswoman Anna Eshoo
Senior Field Representative
Baltazar Lopez
Address of Current Employer of Spouse
Spouse's Job Title
N/A
If you or your spouse is retired and receiving a pension, please state source of pension.
N/A
Question applies to multiple boards
and compile statistical reports regarding the composition of its Board and Interests & Experiences
High School, College, Professional, Vocational, or Other Schools Attended. Please include Major or Field of Study, Dates Attended, Degree and Date of Degree.
B.A. Political Science B.A. Philosophy M.A. Philosophy
List any position or office held in any governmental agency, civic, or charitable organization including the dates
The Santa Clara County Committee on School District Organization Languages Spoken
Spanish
Baltazar Lopez
Special Awards or Recognitions Received
Please state why you want to become a member of this Board or Commission including specific objectives which you would work toward as a member.
Would like to provide a native’s perspective after working across numerous government agencies.
Please state any other information which you feel would be useful in reviewing your application
Life long resident of District 5.
Do you own property in the City of San José?
Yes
No
If yes, please list the addresses here.
Do you rent property in the City of San José?
Yes
No
If yes, is it a month-to-month lease?
Yes
No
State and local law require that you abstain from participation in decisions that may affect your financial interests, including sources of income, interest in real property, personal finances or investments.
In addition, if appointed, you may be required to fill out a disclosure statement which indentifies certain of your financial interest beginning with the immediate twelve-month period prior to your appointment.
Please review the scopr of your
board/commission in Municipal Code Chapter 2.08.
Based on your best judgment, does this
Board or Commission make decisions that may affect sources of income, interests in real property, personal finances or investments of you or your spouse?
Yes
No
If yes, please explain.
Please identify any organizations, associations, corporations, or entities by which you are employed or associated that might be affected by decisions of this Board or Commission, and the positions you hold in these entities.
N/A
Baltazar Lopez
Question applies to multiple boards
If appointed, you will be required to fill out a disclosure statement, which identifies certain of your financial interests beginning with the immediate twelve-month period prior to your appointment and annually on or before April 1 of each year thereafter. Please confirm that you have read Fair Political Practices Commission (FPPC) Form 700 Reference Pamphlet and agree to file required FPPC Form 700 Statements of Economic Interest, as required by current City Council Conflict of Interest resolution.
Yes
No
Question applies to multiple boards
Have you ever been required to file a Statement of Economic Interest (Form 700) and failed to do so?
Yes
No
Question applies to multiple boards
If yes, please explain in complete detail.
Question applies to multiple boards
Please confirm that you have reviewed and agree to comply with the San Jose Municipal Code Chapter 12.08 (Prohibition of Gifts), City of San Jose Ethics Policy (City Policy Manual
1.2.1), and City of San Jose Gift Policy (City Policy Manual 1.2.2).
Yes
No
Reference 1 Name
Omar Torres
Reference 1 Address
Reference 1 Email address
Reference 1 Phone
Reference 2 Name
Peter Ortiz
Reference 2 Address
Baltazar Lopez
Reference 2 Email address
Reference 2 Phone
Supplemental Questions
Question applies to
Board of Fair Campaign and Political Practices,
Civil Service Commission,
Planning Commission
Are you a registered voter in the City of San Jose? (Please note, your voter registration will be independently verified)
Yes
No
Question applies to
Civil Service Commission,
Board of Fair Campaign and Political Practices,
Planning Commission
Please provide the name and residential address under which you are registered to vote. If it is the same as listed above, please note see above.
Baltazar Lopez, 10078 Torrance Avenue San Jose, CA 95127 Question applies to
Board of Fair Campaign and Political Practices
Have you participated as a candidate in any election to public office in the year prior to your application to the Commission? Please note, if you have, you are ineligible for appointment.
Yes
No
Question applies to
Board of Fair Campaign and Political Practices
If you are applying for the Board of Fair Campaign and Political Practices, please indicate any familiarity or experience you may have with campaign laws.
Ran for office several years ago and currently sit on the county committee on school redistricting If applicable, have you ever attended a meeting of the Commission(s) to which you are applying?
Yes
No
Would you be available to attend meetings at the scheduled time?
Yes
No
Please describe your experience in serving on a Commission or Board.
Small decisions can have truly impact changes on residents and it's critical to do extensive background on every vote and comment.
Baltazar Lopez
(Optional) Please upload a resume.
Considering your experience and activities in business, labor, School, professional, social,
Commissions, Boards, or other organizations, indicate the experience, training, knowledge and/or skills which qualify you for appointment to the selected commission(s).
I have worked on policy and neighbors building efforts for years across income levels and racial/religious groups. I understand what has worked and not worked for several communities that vary in vastly different perspectives and resources.
What is your understanding of the purpose of the Commission? To improve the quality of life San Jose residents
Please list three issues facing the City that you feel the Commission should address.
A disconnect between government and local residents. Building trust Upholding the law in a clear and obvious manner
Question applies to multiple boards
Do you meet the requirements for appointment to this commission?
Yes
No
Anything else you would like us to know?
Retirement Board Questions Only
Baltazar Lopez
Verification
By checking the box below, you agree with the following statement.
I agree that all of the information contained in my responses to the questions on this application are true and accurate to the best of my knowledge. I further agree that, by checking the box below and submitting this application, online or otherwise, I am affixing my digital signature to this form as of the date submitted.
I Agree
*
Baltazar Lopez