HomeMy WebLinkAbout02._Application 05, T.Beatty Page 28 of 95
,01&CENTRAL SAN O'FcEl VED
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R 2 4 2023
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APPLICATION FOR POSITION AS BOARDMEMBER
REPRESENTING DIVISION 3
PLEASE TYPE OR PRINT IN INK. completed applications must be submitted to the Secretary of the District at
5019 Imhoff Place,Martinez,CA 94553 or Wo email,kyouna@ centralsan.ora by SOO p.m.on Monday,Man*
27,2023.Applications submitted after the deadline will not be considered. Responses to all items are required
for application to be considered complete.
Applicant Name: `�'�ID rn HS V �-�-
Address: -
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Phone K-u tuber: `
Email Address:
1. Are you a resident of Division 3*? Yes _ No,
'Verification can be obtained diddng the interactive map on the District website at
httos://www.centralsan.org/elections or by calling the Secretary of the District at 925-229-7303.
2. Are you currently a registered voter? Yes No
3. Have you ever been convicted of a felony? Yes No
4. Attach resume and/or list your education,current employer and work experience:
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,�CENTRAL SAN
S. Describe any other relevant current or past experience that would qualify you for this
position,includi ngg the dates of service and the length of time of the experience,
spedfically:
a. Current or previous elected positions or experience with elected boards:
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b. Volunteer services or community partidpadon:
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c. Other group memberships and affiliations:
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: �ENTRAL SAN
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6. Do you have a familial or financial relationship with an employee or Board Member at
Central San?If Yes,please identify the nature of the relationship:
7. Do you have any financial relationships with the District such as grants,contracts,or
other economic relationships?If Yes,please identify the nature of the relationship:
& State your reason for interest in this position and explain why you would be the best
candidate for this seat in SOO words or less. (You may use this form or attach a separate
document for your response.)
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CENTRAL SAN
9. Any additional information you would like to provide for consideration.(You may use
this form or attach,a separate document for your response.)
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hank you for your interest in the Centraln (�
Signed: L;O
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March 30, 2023 Special Board Meeting Agenda Packet- Page 37 of 101