APPLICATION FOR MEASURE K OVERSIGHT COMMITTEE

SUMMARY OF BACKGROUND AND EXPERIENCE

(Applications Received Are Public Record)

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Cell Phone *

Daytime Phone *

Occupation *

Employer *

Email Address: *

Do you live in Pleasant Hill? *

If yes, how many years?

Can you attend daytime meetings? *

Can you attend night meetings? *

High School Attended

Did you graduate?

College Attended

Did you graduate?

Graduate School Attended

Did you graduate?

Trade or Special School Attended

The Transactions and Use Tax Oversight Committee (known as the Measure K Oversight Committee) is comprised of seven (7) voting members who are at least 18 years of age, and have one of the following qualifications (select all categories for which you qualify): *

Member of the Pleasant Hill Chamber of Commerce with a business in Pleasant Hill

Member of the Pleasant Hill Traffic Safety Commission

Member of the Friends of the Pleasant Hill Library

Resident of Pleasant Hill and who is a professional in a financial field

Resident of Pleasant Hill and active in the community

In what way(s) are you currently active in the community? *

0/500 characters

Why do you want to be on the committee? *

0/500 characters

What specific expertise would you bring to the committee that you feel would be of most benefit to the City? *

0/500 characters

Please attach a copy of your resume.

Ethics and Training A Committee member shall not make or influence a City decision related to: (1) any contract funded by Measure K tax proceeds, or (2) any construction project which will benefit the committee member's outside employment, business, or provide a financial benefit to an immediate family member, such as a spouse, child or parent. Each Committee member shall complete ethics training as mandated by State Assembly Bill 1234. *

I have read the above statement and will take the required ethics training if appointed.

Sign your name in the Signature box below: *

clear

Date * +

For information on the application and appointment process, or for an application to be sent to you if submitting this form online is not an option, please contact Juanita Davalos at jdavalos@pleasanthillca.org or 925-671-5283.