Apply for Mosquito and Vector Management District Board

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:Mosquito and Vector Management District Board
ID:2024CNT-27
Resume
Resume:
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Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Attachments
Cover Letter:
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CITY OF SANTA BARBARA ADVISORY GROUP MEMBERSHIP APPLICATION
PERSONAL INFORMATION
Yes   No
Yes   No
YOUTH APPLICANT’S ONLY
Yes   No
Yes   No
Yes   No
EMPLOYMENT INFORMATION

Current Employer

Yes   No
EXPERIENCE/BACKGROUND
Yes   No
Yes   No
STATEMENT OF ECONOMIC INTERESTS

I agree to submit Statements of Economic Interests* in a timely manner, if required, for the group to which I am appointed.

* Additional information regarding Statements of Economic Interests and the Form 700 may be obtained by selecting “Conflict of Interests/Form 700/COI Codes” on the home page of the following web site:

www.fppc.ca.gov.

SIGNATURE

I have read and signed the attached resolution adopting the City’s Nondiscrimination Policy and the Excellence in Customer Service Code of Conduct; and, if appointed, will follow them in the conduct of my duties.

Non-Descrimination Policy.

Code of Conduct.

MVMDB - Specific Question
* Are you a current member of the Santa Barbara City Council?
Yes
No
Voter Registration Questions
* Are you a registered voter within the City of Santa Barbara?
Yes
No
* If you are registered to vote in a different jurisdiction, please list that jurisdiction:
Public Record Acknowledgement
* By submitting this application, I acknowledge that completed applications are considered public records and are subject for production if requested, per Government Code § 7920.530.

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.
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