Application for membership on the Human Relations Commission.

1

Prefix

Prefix

Mr.

Mrs.

Ms.

Dr.

Other: If other, type text here.

2

First and Last Name

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First and Last Name

3

Preferred Pronoun

Preferred Pronoun

He/Him/His

She/Her/Hers

They/Them/Theirs

Ze/Hir/Hirs

Ey/Em/Eirs

Other: If other, type text here.

4

E-mail

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E-mail

5

Home Address

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Home Address

6

City

City

7

ZIP code

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ZIP code

8

Primary Phone

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Primary Phoneext.

9

Secondary Phone

Secondary Phoneext.

10

I certify that I am a resident of the City of Chula Vista and at least 18 years of age.

When applying for a Youth Advisory member: I am a resident of the City of Chula Vista and between 16 and 22 years of age.

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I certify that I am a resident of the City of Chula Vista and at least 18 years of age. When applying for a Youth Advisory member: I am a resident of the City of Chula Vista and between 16 and 22 years of age. (Select an Answer) Yes No

11

How long have you been a resident of the City?   

How long have you been a resident of the City?

12

Please click here to view the interactive map and verify your District of residency

I am a resident of the following City Council district.

 

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Please click here to view the interactive map and verify your District of residency I am a resident of the following City Council district. (Select an Answer) 1 2 3 4

13

Present employer

 *

Present employer

14

Occupation

 *

Occupation

15

Please select the seats for which you are interested and qualify: (select as many as applicable)

 *

Please select the seats for which you are interested and qualify: (select as many as applicable)

Resident of the City At-Large

Youth Advisory Member (non-voting) - 16 to 22 years of age

16

Are you currently serving on a Chula Vista Board/Commission?

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Are you currently serving on a Chula Vista Board/Commission?

Yes

No

17

Which one(s)?

Which one(s)?

18

Have you previously served on a Chula Vista Board/Commission?

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Have you previously served on a Chula Vista Board/Commission?

Yes

No

19

Which ones?

Which ones?

20

Per Chula Vista Municipal Code Section 2.25.030, I understand:

-If I am currently serving on a board or commission, I must resign from my current board or commission if I am appointed.

-I must have served at least 12 months on my current board or commission in order to be appointed to another board or commission.

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I have read and acknowledged the above statement.

21

Are you or have you been involved in any local, civic or community groups?

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Are you or have you been involved in any local, civic or community groups?

Yes

No

22

Which ones?

Which ones?

23

In what ways are you associated with the business and or civic activities of the City? How has your participation reflected the interests and concerns with the protection of the civil liberties of all people which make up the City's residents?

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In what ways are you associated with the business and or civic activities of the City? How has your participation reflected the interests and concerns with the protection of the civil liberties of all people which make up the City's residents?

24

Please describe how you represent the diversity of Chula Vista?

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Please describe how you represent the diversity of Chula Vista?

25

Please describe your interest in fostering better human relations in the City of Chula Vista.

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Please describe your interest in fostering better human relations in the City of Chula Vista.

26

What would you hope to accomplish in the role of a Human Relations Commissioner? (250 words or less)

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What would you hope to accomplish in the role of a Human Relations Commissioner? (250 words or less)

27

Please upload a resume in addition to your application (not required, but strongly encouraged).

Please upload a resume in addition to your application (not required, but strongly encouraged). Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

28

 *

I am familiar with the responsibilities of the Human Relations Commission. I attest that the information I have provided is accurate and true.

29

Where did you hear about this vacancy?

Where did you hear about this vacancy?

City’s Social Media

Chula Vista Library

City’s Website

City Employee

City Board/Commission Member or Staff

Other (please enter text below) If other, type text here.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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