Fillable Community And Senior Services Commission Applicat (Town of Los Gatos)

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Community And Senior Services Commission Applicat (Town of Los Gatos)

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TOWN OF LOS
GATOS
BOARD, COMMISSION, COMMITTEE APPLICATION
Contact: Clerk Department
110 East Main Street, Los Gatos, CA 95030
(408) 354-6888 or
Clerk@LosGatosCA.gov
General eligibility requirements: A resident of the incorporated limits of the Town of
Los Gatos. Other requirements may apply to specific Boards, Commissions, or
Committees.
If you would like to apply for more than one Board, Commission, or Committee, place a number
next to the Board, Commission, or Committee, in order of your preference, for which you would
like to apply. A separate application is required to be submitted for each Board, Commission, or
Committee you are applying for. Only applications for current openings will be considered at this
time. Applications for future openings will be kept on file for one year. Qualified applicants will
be notified for an interview with Town Council.
__ Arts and Culture Commission
__ Building Board of Appeals
__ Community Health and Senior Services Commission
__ Complete Streets and Transportation Commission
__ Council Finance Committee – Resident
__ General Plan Committee
__ Historic Preservation Committee
__ Library Board
__ Parks Commission
__ Personnel Board
__ Planning Commission
__ Sales Tax Oversight Committee
IMPORTANT NOTICES
Please note that all information provided on the application becomes a public record after it is
officially filed. All appointed applicants are required to file the Fair Political Practices
Commission (FPPC) Statements of Economic Interest (Form 700), which are also a public
record. Applicants appointed to the Planning Commission are also required to complete
Ethics Training AB 1234 every two years.
CONTINUE TO PAGE 2
COMMUNITY HEALTH AND SENIOR SERVICES COMMISSION APPLICATION
Contact: Clerk Department
110 East Main Street, Los Gatos, CA 95030
(408) 354-6888 or
Clerk@LosGatosCA.gov
Note: Only the text that shows in the boxes is visible.
Please do not go beyond the borders of the boxes.
FIRST NAME: LAST NAME:
ADDRESS: CITY:
ZIP CODE:
CELL PHONE: WORK PHONE:
EMAIL ADDRESS: HOME PHONE:
EMPLOYER: JOB TITLE:
HOW LONG HAVE YOU LIVED IN LOS GATOS?
*If appointed your name, phone number, and email address will be made available to the public.
Please list all previously held elected or
appointed governmental positions.
Include the Position/Office held and the
associated dates.
(e.g. Mayor, City of San Jose, 1990-1994)
Please list any civic charitable
organizations you have belonged to.
Include the Position/Office held and the
associated dates.
(e.g. Coach, Little League, 1982-1989)
Please list any schools that you have
attended or are currently attending.
Include your major subject area and/or
grade level.
(e.g. San Jose State University, BA in History)
CONTINUE TO PAGE 3
Why are you interested in serving on the
Community and Senior Services
Commission?
Have you ever attended a Community and
Senior Services Commission meeting? If yes,
please provide a summary of your
observation. If not, why not?
How will you balance your personal interests
with the broader role of the Commission?
CONTINUE TO PAGE 4
What do you see as the role of this
Commission?
What, from your perspective, are emerging
needs that you would like the Commission to
address?
CONTINUE TO PAGE 5
What has been your experience or
involvement with grant programs?
All applicants are required to be interviewed to be considered for appointment as a Commissioner.
All applicants will be contacted via email with the interview date and time.
Signature: Date:
IN COMPLIANCE WITH THE AMERICANS WITH DISABILITIES ACT, IF YOU NEED SPECIAL ASSISTANCE TO
PARTICIPATE IN THE INTERVIEW PROCESS, PLEASE CONTACT THE CLERK DEPARTMENT AT (408) 354-6834.
NOTIFICATION 48 HOURS BEFORE THE MEETING WILL ENABLE THE TOWN TO MAKE REASONABLE
ARRANGEMENTS TO ENSURE ACCESSIBILITY [28 CFR §35.102-35.104]
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Community And Senior Services Commission Applicat (Town of Los Gatos)

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Completed 14 July 2020

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