2022 APR I I nil 8: 59
Position
Board/Commission/Comm ittee Applying for*
I Senior Advisory_C_o_m_m_is_si_on ___________ _,
Personal Information
Name* Email*
[Rick Andrews J f
Address*
Street Address
~
Address Line 2
r
City Stale / Province I Region
l Santa clara ] ~
Postal / Zip Code Country
[95054 J i usa
Primary Phone#* Secondary Phone #
Additional Information
k e you eligible to vote In Santa Clara?*
I v es
ke you a registe red voter of Santa Clara?*
[ Yes
Have you atte nded a meeting of this Board/ Commission/ Committee?*
[Yes -----------
Job Title
l Facilities Manager
Work Experience
Present Employer
[valley Medical-Center
Previous Government Bodies/ Elective Offices Applicant has served Government Bodies/
Elective Offices
[_
Position( Office Held
Civic or Charitable Organizations to which Applicant has belonged From Date
Civic or Charitab le Position Held From Date
Orga nization L ::=J ._ _________ J I __ _
Special Interests , Hobbies or Talents
[._
High School, College, Professional, Vocational Schools attended High School, College, Professional, Major Subject
Vocat iona l School
To Date
To Date
IC
Degree Dates I Anticipa ted
Graduat ion
]
=1
[~;1'1-!~~l:l s!ate
Special awards or recognition received
Reasons
Please state reasons why you want to become a member of this Bomd/Commission/Committee, including what specific objectives you would be working toward as a member of this advisory board:
Additional Information
Any other information which you feel would be useful to the City Council in reviewing your application:
Conflict of Interests
Are you associated with any Organization/Employment that might be deemed a conflict of interest in performing your duties if appointed to this position?
[
Abstaining from Votes
City policy directs all advisory body members not to vote on matters where there exists a potential conflict of interest. Would you be willing to abstain from voting if such a conflict arises? Signature and Acknowledgement
Signature*
By clicking submit you are confirming that you are the person listed in this application, and that all information provided is truthful and correct. All information provided will be public information.