ࡱ> >@=O bjbj 4,tete+834g$_%*|||$$$$$$$$'?*%|||||%%NNN|F$N|$NN: #,#pnB^"6# $/%0_%@#R*P*#*#8||N|||||%%4|||_%||||*||||||||| : INDEPENDENT CITIZENS OVERSIGHT COMMITTEE FOR MEASURES B & CC DESERT COMMUNITY COLLEGE DISTRICT APPLICATION FOR APPOINTMENT California law requires certain persons to be represented on the Citizens Oversight Committee (Committee) College Support Group Name: ______________________________________ If possible, please provide a contact person and phone number of the organization in which you are active. The District may contact these organizations to verify your participation. Attach extra sheets, if necessary, to complete this application. General Information: Name: ______________________________________________________________________________ Home Address: _______________________________________________________________________ Home Telephone: ________________________________E-mail: _______________________________ Employer Information: Name of Employer: ____________________________________________________________________ Work Address: ________________________________________________________________________ Work Telephone: ______________________________________________________________________ Educational Background (Response optional; you may attach a resume or additional pages, if needed): College and/or University: ______________________________________________________________ Degree/Major: ________________________________________________________________________ Vocational and/or Other Institution: _______________________________________________________ Certificate/Technical Training: ___________________________________________________________ Additional Information: 1. Have you been a member of any College District committees? ___Yes ___ No If yes, in what capacity? _________________________________________________________________________ 2. Are you or have you or a member of your immediate family ever been employed by the District? ____ Yes ____ No If yes, please explain: 3. List present or past membership in any community service organizations (e.g. volunteer, civic or youth). 4. List participation in professional seminars, workshops or organizations. Qualifications: 1. Describe your training and experience in finance, facilities, and/or construction. (Attach additional pages or resume, if needed.) Please Answer the Following Questions: 1. How long have you been a resident within the District? Years Months 2. Do you have any family members who now attend (or have attended) one of the COD campuses or educational centers? ____ Yes __ No If yes, which campus or centers? 3. Do you know of any reason, such as a potential conflict of interest, which would adversely affect your ability to serve on the Citizens Oversight Committee? __ Yes ___ No If yes, please explain: 4. Explain why you would like to be appointed to this Committee. (Attach additional pages, if needed.) 5. Are you a vendor, contractor, or consultant of the District? _ Yes __ No If yes, please explain: 6. Are you available to attend Committee meetings on weeknights? Yes _ No If no, please explain: Certificate of Applicant: All answers and statements in this document are true and complete to the best of my knowledge and belief. Signature: Date: The original completed signed application should be mailed to the Presidents Office, Community College District, 43-500 Monterey Avenue, Palm , CA 92260. Please be aware that completed applications are public records available for public review. If you have any questions, please call (760) 773-7482.      PAGE \* MERGEFORMAT 2  568=>JRS} - . 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The application is responsible for updating this value after each revision. ormDocumentLibraryFormDocumentLibraryForm Oh+'0d    , 8DLT\ ssiqueirosNormal Mark Howard8Microsoft Office Word@^в@އ@lGck@:;P3 FCitizens' Oversight Committee Application for College Support Member