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BOARDS, COMMITTEES, AND COMMISSIONS APPLICATION

  1. Contra Costa County

  2. Contra Costa County CLERK OF THE BOARD 651 Pine Street, Rm. 106 Martinez, California 94553- 1292 PLEASE TYPE (Each Position Requires a Separate Application)

  3. Check appropriate box if you possess one of the following:

  4. Degree Awarded

  5. Enter Another College/University?

  6. Degree Awarded

  7. Enter Another College/University

  8. Degree Awarded

  9. Certificate Awarded

  10. PLEASE FILL OUT THE FOLLOWING SECTION COMPLETELY. List experience that relates to the qualifications needed to serve on the local appointive body . Begin with your most recent experience. A resume or other supporting documentation may be attached but it may not be used as a substitute for completing this section.

  11. Volunteer

  12. Volunteer

  13. Volunteer

  14. Volunteer

  15. How did you learn about this vacancy ?

  16. Do you have a Familial or Financial Relationship with a member of the Board of Supervisors ? (Please see Board Resolution no. 2011/55, attached ) :

  17. Do you have any financial relationships with the County such as grants, contracts, or other economic relations ?

  18. 1. This application is a public document and is subject to the California Public Records Act (CA Gov. Code § 6250 - 6270). 2. Send the completed paper application to the Office of the Clerk of the Board at: 651 Pine Street, Room 106, Martinez , CA 94553 . 3. A résumé or other relevant information may be submitted with this application. 4. All members are required to take the following training: 1) The Brown Act, 2) The Better Government Ordinance, and 3) Ethics Training. 5. Members of boards, commissions, and committees may be required to: 1) file a Statement of Economic Interest Form also known a s a Form 700, and 2) complete the State Ethics Training Course as required by AB 1234. 6. Advisory body meetings may be held in various locations and some locations may not be accessible by public transportation. 7. Meeting dates and times are subject to change and may occur up to two days per month. 8. Some boards, committees, or commissions may assign members to subcommittees or work groups which may require an additional commitment of time.

  19. N THE MATTER OF ADOPTING A POLICY MAKING FAMILY MEMBERS OF THE BOARD OF SUPERVISORS INELIGIBLE FOR APPOINTMENT TO BOARDS, COMMITTEES OR COMMISSIONS FOR WHICH THE BOARD OF SUPERVISORS IS THE APPOINTING AUTHORITY NOW, THEREFORE, BE IT RESOLVED THAT the fol lowing policy is hereby adopted: 1. Mother, father, son, and daughter; 2. Brother, sister, grandmother, grandfather, grandson, and granddaughter; I. SCOPE: This policy applies to appointments to any seats on boards, committees or commissions for which the Contra Costa Co unty Board of Supervisors is the appointing authority. II. POLICY: A person will not be eligible for appointment if he/she is rela ted to a Board of Supervisors’ Member in any of the following relationships: 3. Great - grandfather, great - grandmother, aunt, uncle, nephew, niece, great - grandson, and great - granddaughter; 4. First cousin; 5. Husband, wife, father - in - law, mother - in - la w, son - in - law, daughter - in - law, stepson, and stepdaughter; 6. Sister - in - law (brother’s spouse or spouse’s sister), brother - in - law (sister’s spouse or spouse’s brother), spouse’s grandmother, spouse’s grandfather, spouse’s granddaughter, and spouse’s grandson; 7. Registered domestic partner, pursuant to Californi a Family Code section 297. 8. The relatives, as defined in 5 and 6 above, for a registered domestic partner. 9. Any person with whom a Board Member shares a financial interest as defined in the Political Reform Act (Gov’t Code §87103, Financial Inter est), such as a business partner or business associate.

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