2. Description:
   The Historic Preservation and Cultural Resource Commission will consist of five members whose responsibility is to advise the City Council, Planning Commission, and all City departments and staff on all matters relating to the identification, protection, retention, preservation, and registration of Cultural Resources in the City.
4. Meetings
   Meetings occur on the second Monday of each month at 6:30 p.m. at the City Hall Council Chamber.
6. 1. Personal Data
   Please enter your personal data below.
8. First Name*
9. Last Name*
11. Phone Number*
12. Email: *
14. Home Address*
15. City*
16. State*
17. Zip*
19. Name of Employer
21. Work Address
22. City
23. State
24. Zip
26. 2. Work Experience
29. Describe your duties:
31. 3. Education and Training
33. Please comment on education and training as it may related to your application:
35. 4. Please enter your professional licenses, certifications or registrations:
37. 5. Please enter your personal and community affiliations:
39. 6. Briefly explain why you are interested in serving on this Commission:
41. 7. Do you have any restrictions pertaining to meeting attendance?

    1. Yes
    2. No
43. If yes, please explain:
45. 8. Do you or an immediate family member have any professional or financial relationship that may present a potential conflict of interest for this commission?

    1. Yes
    2. No
47. If yes, please explain:
49. Pursuant to the City's Conflict of Interest Code, members are required to file a Statement of Economic Interests (Form 700). Members are also required to complete AB1234 Ethics Training within one year of appointment and every two years thereafter.
51. Are you willing to file a Statement of Economic Interests and complete AB1234 Ethics Training as required?*

    1. Yes
    2. No
53. References - Please provide three personal/professional references
55. 1. Name
56. Phone number:
58. Address
59. City
60. State
61. Zip
63. Reference Type*
    -- Select One --Professional ReferencePersonal Reference
65. 2. Name
66. Phone number:
68. Reference Type*
    -- Select One --Professional ReferencePersonal Reference
70. Address
71. City
72. State
73. Zip
75. 3. Name
76. Phone Number:
78. Address
79. City
80. State
81. Zip
83. Reference Type*
    -- Select One --Professional ReferencePersonal Reference
85. Disclosure
    Please note that this is a record that is subject to disclosure under the California Public Records Act.
87. You may attach a resume and/or additional pertinent information.
Leave This Blank:


89. 1. Receive an email copy of this form.
90. Email address

    This field is not part of the form submission.

91. Submit Submit and Print

* indicates a required field