4. ADDITIONAL INFORMATION: The City Council would like more information about your interest in
serving on an Advisory Body. Please indicate your comments and views relative to the subject matter
of the Advisory Body (ies) for which you are applying: (Attach pages if desired.)
5. SIGNATURE: READ CAREFULLY – Complete Section A or B then SIGN
I understand that, if I am appointed to an Advisory Body, I will be required to comply with: the City’s Ethics
Policy, Advisory Body Policies and Conflict of Interest Code; applicable provisions of the Political Reform
Act including filing financial interest disclosure statements (Form 700); and applicable provisions of the
Brown Act; and that I must complete state-mandated ethics training and sexual harassment prevention
training courses. I understand that, while City staff will make a good faith effort to educate me regarding
these requirements, I am responsible for my conduct as an Advisory Member. I understand that all
Advisory Body Members serve at the pleasure of the City Council and may be removed from office due to
poor attendance, unacceptable conduct, or for any other reason.
I understand that Advisory Body members are volunteers, are not City employees, and do not receive
benefits or protections other than workers’ compensat
ion in case of injury in the course of duty. I
understand that this is a public document, and that information contained within it may be provided to the
public upon request. In regard to the online availability of my information, I declare the following:
A. If I am appointed, I authorize the City to post the following contact information (check applicable
below) on its website. I understand that other websites not controlled by the City may provide
links to a City webpage that has my personal information on it. I also authorize the City to update
my personal contact information on its website if my contact information changes.
Cell Phone Home Phone Work Phone
Personal Email address Business Email address
Further, if my home address and telephone number are otherwise non-disclosable under the California
Public Records Act (California Government Code 6250 et seq.), I understand that by agreeing to the
release of the informaiton above, this informaiton may be provided by the City in response to a request
made under the Public Records Act.
OR
B. If I am appointed, I do not authorize the City to post my contact informaiton on its website. The
City may however, disclose on the internet and in all other venues that fact that I serve on a City
Advisory Body.
Applicants Signature: ________________________________________ Date: __________________
Assigned to Commission/Committee/Board:
Planning Commission Library Board Evidence of Hemet Resident
Infrastructure Commission Measure U Committee Evidence Sphere of influence)
Mobile Home Rent Review Commission
Staff Initials: _________
Expiration of Term:__________
