SAN JOAQUIN REGIONAL TRANSIT DISTRICT … meetings/agendas/012814/bos...SAN JOAQUIN REGIONAL TRANSIT DISTRICT (SJRTD) BOARD Board Contact & Phone Number Donna DeMartino, General Manager/CEO

SAN JOAQUIN REGIONAL TRANSIT DISTRICT (SJRTD) BOARDBoard Contact & Phone NumberDonna DeMartino, General Manager/CEO San Joaquin Regional Transit District (SJRTD); 421 E. Weber Avenue; Stockton, CA 952023024; 9480645 (Ericka Rocha, Senior Adm Assist 4676613));

Incumbent Category/Appointed By Appointed TERM

Restuccia, Michael Board of Supervisorsʹ Appointee Board of Supervisors

11/6/2012 11/04/2012 11/08/2016

Isetti, Duane Board of Supervisorsʹ Appointee Board of Supervisors

3/1/2011 02/20/2011 02/20/2015

SINGH, Balwinder Stockton City Council Appointee Stockton City Council

10/22/2013 01/01/2014 12/31/2017

Giovanetti, Gary Stockton City Council Appointee Stockton City Council

4/24/2012 07/01/2012 06/30/2016

Bauer, Joni D. Stockton City Council/San Joaquin County Board of Supervisors Joint Appointee Stockton City Council/San Joaquin County Board of Supervisors

8/3/2010 01/22/2010 01/22/2014

Page 1 of 1County of San Joaquin - Boards, Commissions & Committees (v.0.1) - Roster - Library

1/14/2014http://sjcvmwebapp1/boardscomm/rptRoster.aspx

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SAN JOAQUIN REGIONAL TRANSIT DISTRICT BOARD

Stockton City Council/San Joaquin County Board of Supervisors

Joint Appointee

List of Applicants for Consideration on January 28, 2014

1. Joni D. Bauer (Incumbent)

2. Renee Elliott

3. Ernesto Angel Gonzalez

4. Michael William Keatts

5. Chris Kotsoglou

6. John William Mays

7. John A. McGaughey

8. Gregory Stephen Pitsch

9. Monique Christina Sauceda

10. Lucinda R. Soule

KEN VOGEL Chairman

Fourth District

BOARD OF SUPERVISORS 44 N. SAN JOAQUIN STREET, SUITE 627

STOCKTON, CALIFORNIA 95202 TELEPHONE; 209/468-3113

BOBELLIorr Vice Chairman Fifth District

CARLOS VlLLAPUDUA First District FAX; 209/468-3694

DEC 30 2013 FRANK L. RUHSTALLER

Second District

RECEIVED SAN JOAQUIN COUNIT

APPLICATION FOR APPOINTMENT STEVE J. BESTOLARIDES

Third~District

TO BOARDS/COMMISSIONS/COMMITTEES

JONI D. BAUER NAME

THIRD DISTRICT

SUPERVISORIAL DISTRICT (If UllkIlOWII, cOlltact Clerk of the Board)

975~tb§~~bR7C~~I¥~rnia 95209-1140

RESIDENCE ADDRESS City/St/Zip 9758 TREETOP DRIVE STOCKTON, CALIFORNIA 95209-1140

MAILING ADDRESS

jdbauer [email protected]

EMAIL

(209) 951-6821

FAX

SAN JOAQUIN REGIONAL TRANSIT DISTRICT

~OARi;2!COMMISSION/COMMITIEE

CATEGORY Please check olle; Incumbent [XJ New Appointment 0

(209) 951-6821 RESIDENCE PHONE

ORI ENTATION AN.D MOBILITY SPECIALI ST

OCCUPATION ]30 WEST FLORA STREET STOCKTON, CALIFORNIA 95202-1636

BUSINESS ADDRESS

(209) 466c}836 BUSINESS PHONE

Briefly state how you learned of the opening: I am the incumben t. I rece i ved a 1 etter from

the Clerk of the Board informing me my term w·il.l expire on January 22, 20J4.

Briefly state your experience which you feel would be helpful should you serve on this

~Commission/Committee: I have served on th.e San Joaqu i n Reg i.ona 1 Transi t Dis tr i ct Board since 2006, as vice-chai r in 2007 ami ch"ip in 200Bo I. served on the finance and personnel committees and cllrrently, S·erve 00 the fi'oaoce committee and Retirement ,?oard. I am a'frequent transit user and teach people wh.o are 51 rnd to use publiC transportation,

Special ist, Community Center for the Assoc I at Ion of Or rentat Ion and I~ob i 1 i ty

S n FrancIsco State Universit ."7". resen ; preseo Sea ls

Professional and/or other community organizations on which you serve:San Joaqu in Reg ionq 1

Traniit District Access Advisor Committee; San Joaquin Council of Goyernments Social Services Transp'ortatlon Visor\{ ommltteei a I 9rnl<l lssocla Ion of h' Orientation and Mobil ity Special ists. Stockton ~Icycle ub Ue ta Lentury co-c air.

THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION

., ~ducation: Bachelor of Science, California State University, Los Angeles, 1975; " aasstteerr of ~r5tsr 5DeCial Etduct"tlon, y"llfornla Statf: University, Los Alnqeles~81977;

o u I C AdmlnlS ra ron, ..... a I ornla sta:ee university, o.~anI'S atls, IJ~ •.

long ~Istance cycling; travell,ng and navigating transit Personal Interests & Hobbies: __________________________ _

systems In other parts of the United States; organizing special events for

char I ty.

Are you an employee or officer of the County, any City in the County, the State, or the Federal government? Yes D No []]

Are you related by blood or marriage to any employee or officer of an agency which is subject to the Board, Committee or Commission to which you are seeking appointment? Yes DNo EI

Are there any facts of which you are aware that would cause you to have an actual or apparent conflict of interest with respect to the position to which you are seeking appointment? Yes DNo EI

If "Yes", you 'will be asked to submit the facts in writing for review before your consideration of appointment.

Have you ever been' convicted of a felony which would disqualifY you frop:l appointment? Yes DNo [Xl

If you answer ''Yes'', please list the nature of the conviction and the date and court in which the conviCtion

was entered. ___________________________________ _

• If you are appointed, you may be required to be bonded for your performance. If you are appointed and cannot be bonded as required, your appointment will be revoked.

• ' If you desire a p'ersonal interview or wish to address the Board of Supervisors, you may contact the Board Office direcdy at (209) 468-3113.

• If you desire to provide additional information, please attach it to this application.

Please return application to: Clerk ofthe Board

JlE,CE}16,E,R 23 v +OJ:L DATE

44 N. San Joaquin Street, Suite 627 Stockton, CA 95202

If you have any questions, please feel free to call the Clerk ofthe Board Office at (209) 468-2350.

Revised APRIL 2013 Page 2

CITY OF STOCKTON JAN 3 I -,. ;

( tlton

If APPLICATION FOR APPOINTMENT CI 1 g~

AND BACKGROUND INFORMATION F06)-~Ci!.!.ITV!..lOB:.F.ilJST~OCdC>KT.J.!,!O~N __ 1

BOARDS, COMMISSIONS, AND COMMITTEES

1) Please provide all Information requested. 2) Please print or type ali entries In black or blue Inllonly. 3) Any attachments must be single sided, 8 Y, X 11 paper. 4) Information contained on this form Is public record. 5) With the exception of the Information contained on this lirst page, all other inform.tlon contained In this application may be

posted on the City's website for public view. 6) Submit completed application to: Office of the City Clerk, City Hall 1st Floor, 425 North EI Dorado Street, Stockton, CA

95202; Phone: (209) 937-8459 Building Housing BOAj CAPACj Regional Transit District Boardj Measure W Ove~sigh~j Watrr Advisory Group

BOARD/COMMISSION/COMMITTEE NAME: VA f-I /)V\.J . ~c~o~m~p~le~teFs?u~p~p~'e~m=e~nt~a~IQ~u-e-s~tio-n-n-a~ira-,7.if~a-p~pl~ic-ab~l-e-----

Applicant Name: _E.c."I_ol_1 ---,,..-,--'.R_e.c.n • ...;.e _________ =--:-______ -==7,'-___________ _ Last First Middle

Home Address: 739[.ora11aCI. SlooklOll,CA 952()T

Street Address City state Zip Mailing Address (if different than home address) ___________________________ _

Preferred Contact Phone ( )_2_09_-_64_9_-7_05_1 ________ Alternate Phone (

Business Phone ( ) 209-466-2448 Fax (

I declare under penalty of disqualification/termination that I have been a resident at the above address for 3 & 112 years

Resident of City Council District No.:..3- Are you an incumbent? Yes __ No _x __ (length 01 time)

The City of Stocldon uses email as the preferred method of communication regarding your application. Is this acceptable to you? Yes _x__ No __ . If you have checked "No", please Identify how you prefer to be contacted: ________ _

Email Address: relllot!3@::;al:::l.n"'"::.I ___________ _

Employer Name Person Centered Services

Employer Address 240 N. Union Sireel Siocklon, CA 95203

-Voter Registration: The City of Stockton requires members of the City Council Salary Setting Commission, Civli Service Commission/Equal Employment Commission, and Sen Joaquin County Mosquito and Vector Control District to be registered voters of the City of Stockton. Please fill out the information below if you are applying for one ofthase positions so that your voter registration may be verified:

Name: ,cheryl Renee Elliot!

Address: ~ret!=a-=C:::t. _________ _t-----

City: Stocklo::.n:-.-/-1-__ ,..-_,,_-,. ~~2.!====-:--

Signature: --"''''-''''''<-f-+--+=--H''''-'C-.lI+..:oq,,.-----

(Form adopted by City Council on 10-10-95; Revised 12113/10) r>.IF"\",,,,,,~~Y.f~ ...... ...J ""U! .. "'~\"h ..... f" .. I"'I.,.."r.I:'C>T ........... "'·.,.("\~l\n~ .. n,..,.. ....... ~ ... f"'\~".,r:::QaJ: " ,J""

City of Stockton APPLICATION CONTINUED Page 2 of 5

Ranal! EUloU

Please state the reason you would like to be a member of this board/commission:

APPLICANT NAME

To further 911.tn !lKparienoo and knowledgB III aBlVlng my (jammu"!ty. To bo an nollve partlolpant In lor-el govarnln9nl Dnd \0 nlOko ourcomtnunlly stronger,

Have you served on an advisory group before? ~ If yes, please explain: ________________ _

How did you hear about the position? .:c'"",',-"'''"Y'',-"w,,,''::''',,-' ______________________ _

City Council Polley 100-2 states that board/commission members are required to attend meetings on a regular basis, If appointed, will you be able to attend meetings regularly and devote the time necessary to fulfill your duties as a member? Yes x No

Do you or Immediate family members have any relationship (professional, financial, other) that may present a potential conflict of interest for this advisory group? Yes ___ No _x __ If yes, please explain __________________________ , _______ _

SUPPLEMENTAL QUESTIONNAIRE: Please complete the following if applying for a vacancy on any of these listed boards/commissions/committees:

III 49-99 Cooperative Library System Advisory Board You must be a resident of San Joaquin County, but not the City of Lod!' Do you meet this requirement? III Yes 0 No

o Stockton Arts Commission Outside of your profession indicate what type of Arts you are active in (circle any that apply): Music, Dance, Theater, Cinema, Photography, Architecture, Art Criticism, Textile Arts, Literary Arts, the Visual Arts, including (but not limited to) the Public or Environmental Arts, Graphic Arts, Design, Drawing, Painting, Printrnaklng, SClllpture, Ceramics, and Art History Are you interested In or accomplished in fund-raising? 0 Ves 0 No

III Building and Housing Board of Appeals/ Handicapped Access Board of Appeals Do YOll have experience In any of the following areas (circle any that apply): General Building Contractor, Plumbing Contractor, Electrical Contractor, or Mechanical Contractor; Engineer or Architect. Are you a disabled citizen? 0 Yes III No

o Central Parking District Advisory Board Do you own real property or are you an executive officer of a corporation that owns real property within the Central Parking District? 0 Ves 0 No Specify property address(es): '

III Climate Action Plan Advisory Committee Do you actively represent any of the following interest groups within the City of Stockton (circle any that apply): Environmontal, Non-Profit Community Organization, labor, Business, Developer

o Cultural Heritage Board Are you knowledgeable have experience in, or extensive background in any of the following areas (circle any that apply): Historic or cultural traditions of the community, preservation, architecture, construction technology, real-estate, construction industry, California licensed Architect, Historian, Stockton resident for 40 years or longer,

o Development Oversight Commission Do you work In Stocl(ton or with a firrn/organization that does business in Stockton? III Yes 0 No State name/address of firm/organization: ::':p:;:,.:::'":,:0"''':;:'.:::;''',,5::::,"''''o::'''-_________ , Are you any Of the following (checK any that applY) o local architect/designer 0 local Civil Engineer 0 Mixed Use Builder/Developer o Local Representative from public at-large 0 local Non Profit Builder/Developer o Port of Stockton Executive (CEO or Designee) 0 San Joaquin Partnership Executive (CEO or Designee) Building Industry Association 0 Executive (CEO or Designee) Q[ 0 Mixed Use Builder/Developer Builder's Exchange 0 Executive (CEO or Designee) Q[ 0 General Contractor

C:IDoouments and Setllngslbhunter.CITYOFSTOCKTONlMy Documentsl125665-1 ,doc (Form adopted by City Counoll on 10-10-95; Revised 12-4'" 'In\


o Port Commission

Renee Elliott

APPLICANT NAME

Do you reside within the POlt District boundary or consistent with the City General Plan boundaries, plus a one-half mile strip on either side of the Stocllton Ship Channel from the Port to Disappointment Slough, If so for how long?

o Public Art Advisory Committee (circle any that apply) Employed as a professional visual artist, critic of contemporary visual art forums, or have knowledge of, or skill/experience in any of the following: activist for the visual environment, publlo art, regional/national individual artists work, understanding of ethnic/gender diversity, the Stockton Public Art Plan prooesses and Implications for the City, decision-mailing ability, . willingness to tolerate/promote ohange, new artistic & design expressions, community activities significant enough to confirm knowledge of isslies and individuals within the community. Must be a resident of Stockton for at least 3 year •.

[jJ San Joaquin Regional Transit District Board Have you resided within the Transit Distrlot boundaries for at least one year? [jJ Yes 0 No Are you a resident In the City of Stockton? [jJ Yes 0 No

[jJ Sports Commission (circle any that apply) If you are not a resident of Stockton, do you own and/or operate a business within the City or are a sponsor or associated with a sports related event, name of business or event(s): -::"::.' ______ . ___ . ___________ _

[jJ stockton Measure W Oversight Committee Do you reside within Stockton's geographic boundary? t8 Yes 0 No Are you at least 28 years of age? [jJ Yes 0 No Are you an employee of any vendor, contractor or consultant doing business with the City of Stockton? 0 Yes ~ No

[!jJ Council Water Advisory Group Do you reside within one of the Stockton Municipal Utilities' three utility service areas? [jJ Yes 0 No If so, state which one: -'Cc::!"y'--_______________ _

o Youth Advisory Committee (fill in, circle, or check) High school enrolled In: Will you be a senior next committee term? DYes ONo Are you a member of one of the following Community Centers? McKinley, Seifer! and Selrra Vista, Stl1bley and Van Buskirk, other: Which-;cO:-o"'u"'n':'ci:;-1 "'DC:is""tr-'-:ic""t d::;o::-y"'0C:u::-rC:e':'sl;-:;dC:-e-;:ln~?""D:;:ls:Ctr:Cio:;:t-:;1 ,---'2, 3, 4, 6, or 6 (leave blank If you do not know).

BACKGROUND INFORMATION

WORK EXPERIENCE: List names, addresses, and dales of employers for the last five (5) years. Attach additional sheets of paper if needed.

FROM: MO. Nov. _DAY 28th YEAR 1998 EMPLOYER NAME Person Centered Services (peS)

TO: MO . .£resentDAY ____ YEAR--ADDRESS~~O --t!., IA MOYt-2utoa1~_ DUTIES: Program Manager: suparvlslon and Ir'dlnlilg ofs\llff, currlculum development, IlIQrfand student schedulo coordnator, general trouble shooting, teacher ofaludent groups, ate,

FROM: MO. ____ ,DAY ___ YE.AR, ____ EMPLOYER NAME.. ___ _

TO: MO. DAY YEAR ADDRESS, ___________________________ __

DUTIES: ________________________________________ ~ ___________ _

BUSINESS ENTERPRISES: List business name, including fictitious name and address of any business enterprises currently or previously owned or operated.

FROM: MO. __ DAY ___ YEAR BUSINESS NAME. ____________________ __

TO: MO. ___ DAY YEAR ___ ADDRESS ____________________________________ __

C;\Documents and Seltlngs\bhunter.CITYOFSTOCKTON\My Documents\125665-1.doc (Form adopted by City Council on 10-10·95; Revised 12-~":I ..rn\


Renee Elliott APPLICANT NAME

lYPE OF BUSINESS OR SERVICE RENDERED: _________________ _

A resume reffecting experience, community activities, or other qualifications not listed below mpY be attached In order to assist the Council in evaluating your application. (Optional) 5~~ tt{rto.<!-~1

EDUCATION: Bachelor'S from CSU Stanislaus

CONFLICT OF INTEREST: State and local law requires that you abstain from participation in decisions that may affect your financial interests, Including sources of Income and interest in real property 01' investments. In addition, If appointed you may be required to fill out a disclosure statement that identifies certain of your financial interests beginning with the Immediate twelvemonth period prior to your appointment. Based on your best judgment, does this board or commission make decisions that may affect any sources of Income, interests in real property, or Investments of you or your spouse?

Ves __ No _X __ If yes, please explain. Identify any organizations, aSSOCiations, corporations, or entities by which you are employed or associated that might be affected by decisions of this board or commission and the positions you hold. __________________________________ _

INFORMATION REGARDING CONFLICT OF INTEREST AND FILING OF STATEMENTS OF ECONOMIC INTERESTS

In accordance with Government Code Sections 87300 - 87313 and the City of Stockton's Conflict of Interest Code, this Board/Commission/Committee may be designated to file Statements of Economic Interests.

If you are appointed to this Board/Commission/Committee, you may be required to file statements disclosing certain types of Information so that the public can be made aware of potential conflicts of interest. The types of disclosure are:

Investments Interests in Real Property (other than your residence) Interests in Real Property Held by a Business Entity or Trust Investments Held by a Business Entity or Trust Income (other than loans and gifts) Income - Travel Payments, Advances, Reimbursements Income Gifts Business Positions Commission Income Received by Brokers, Agents, and Salespersons Income and Loans to a Business Entity or Trust Income from Rental Property

If you have any questions regarding disclosure requirements, please contact the City Clerk's Office at 937-8458.

CONVICTIONS: Conviction of a crime Is not necessarily a bar to appointment. Each case Is considered separately based on requirements of the position; however, failure to list convictions may result in disqualification.

1. Have you ever been convicted of a felony? If yes, please explain:

no

2. List each civil action, if any, in which punitive or exemplary damages have been assessed against you, indicating In each instance the date of the trial, court judgment and the location of the court which rendered the judgment:

N/A C:\Documents and Settlngslbhunter.CITYOFSTOCKTON\My Doouments\125665-1.doc (Form adopted by City Council on 10-10·95; Revised 12-~? ~,...,


Renaa Elliott

APPLICANT NAME

I DECLARE, UNDER PENAL TV OF DISQUALIFICATION AND TERMINATION, THAT ALL STATEMENTS IN THIS APPLICATION' TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDG /

Date -"""'-271""3'--_________ _

Please identify any specialized accommodations needed for equal participation: .::NI;::A _____________ _

The following information Is voluntary and is gathered in accordance with state and Federal laws for the purpose of evaluating the effectiveness of our Affirmative Action and recruitment efforts. Please check: Male x Female

.2swhlte (Not Hispanic Origin) All persons having origins in any of the original peoples of Europe, North Africa or the Middle East

~Black (Not Hispanic Origin) All persons having origins in any olthe Black racial groups of Africa.

_Hispanic All persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.

_American Indian or Alaska Native All persons having origins in any of the original peoples of North America and who maintain cultural Identifications through tribal affiliation or community recognition. Please identify your tribal affiliation.

_Filipino All persons having origins in the Philippine Islands.

_Asian

The Stockton City Council appoints members to the various City of Stockton Boards and Commissions. The Council also appoints representatives to serve on various other San Joaquin County agencies as well. Please check the boxes below if you are interested in serving on any other boards/commissions. To find out about what these boards/commissions do and if you qualify, please visit the City of Stockton website at www.stocktongov.com/commissions

iji49-99 Cooperative Library System Advisory Board

DArts Commission

ijiBuilding and Housing Board of Appeals

OCentral Parking District Advisory Board

jj]City Council Salary Setting Commission

OCivii Service and Equal Employment Commissions

ijiClimate Action Plan Advisory Committee

ijiComrnunlty Development Committee

OCultural Heritage Board

ODevelopment Oversight Commission

ijiHandicapped Access Board 01 Appeals

ijiMeasure W Oversight Committee

OParks and Recreation Commission

iji Planning Commission

o Port Commission

o Public Art Advisory Committee

iji Redevelopment Commission/Relocation Appeals Board

iji San Joaquin County Commission on Aging

o San Joaquin County Mosquito And Vector Control District

iji8an Joaquin Regional Transit District Board

ijiSPOlts Commission

ij} Water Advisory Grollp

o youth Advisory commlsslon'(must be in high school to serve on this Commission)

C:\Documents and Setllngs\bhunter.CITVOFSTOCKTONlMy Documents\125665-1.doc (Form adopted by City Council on 10-10-95; Revised 12" 4 ') ~ n\

Resume of Experience, Community Activities, etc.

Renee Elliott

1. Created first San Joaquin Pride Center (now defunct) in 2008, served on Board of

Directors.

2. ApPointed as District 2 Representative for SJC Democratic Central Committee. Served 2

years as Recording Secretary.

3. Elected District 2 Representative for SJC Democratic Central Committee. Currently

serving as Vice Chair.

4. served on Fundraislng and Outreach Committees of SJC Democratic Central Committee

doing outreach and voter registration at various events In the County for the last 4

years.

5. Salved 2 years as Membership Coordinator of San Joaquin Grassroots Action.

6. Served 2 years as Volunteer Coordinator of San Joaquin Grassroots Action.

7. Coordinated 4 National Day of Service events at St. Mary's Dining Hall.

8. Assisted on various campaign teams for candidates seeking election for the last 4 years.

, .sS" CITY OF STOCKTON

,0 1...a...lOl-~,,-,,---.~l Stockton

NOV I 5 2012 ~ t!!lti 'IIII.'

APPLICATION FOR APPOINTME~ __ S!!l.!W!.!.2!.2!W!.!L--' i~~~ AND BACKGROUND INFORMATION FOR


1) Please provide all information requested. 2) Please print or type all entries In black or blue Ink only. 3) Any attachments must be single sided, 8 Y, X 11 paper. 4) Information contained on this form Is public record. 5) With the exception of the Information contained on this first page, all other Information contained In this application may be

posted on the City's website for public view. 6) Submit completed applic~tion to: Office of the City Clerk, City Hall 1 st Floor, 425 North EI Dorado Street '" Stockton,~

95202; Phone: (209) 937-8459 ~ ," .. '\ 'lIU,J,/.L 111\ . D i",_ JJ /I-dt!, _ _ _ IUea.Wfw,Ctv(-1JY / V1nf),\tf, t rlft,/lvTI tvll_ rt

BOARD/COMMISSION/COMMITTEE NAME: I C ".1\ \' \t:€,. _~, !I\': S i ~Y\' Complete Supplemental Questionnaire, If applicable

Applicant Name: ()O'l'I'!:: ",\e,;z. [(''1\ <!-'i:.Io AV\~e..\ l,ost ~ FlrsL Middle

Home Address: \ \ jby \)" c\on" tw~ 8-1tx~\nA Ch q S.:lo 3 street Address City State Zip

Mailing Address (if different than home address) ______________________ _

Preferred Contact Phone (~.25 ) 07'8 - <l,"\ 1 f.o Alternate Phone (

Business Phone ( Fax (

I declare under penalty of disqualification/termination that I have been a resident at the above address for O1,~rs 5 V (le1'i'gth of time)

Resident of City Council Distrkt No.: __ Are you an incumbent? Yes __ No_"_

The Citiff stockton uses email as the preferred method of communication regarding your application. Is this acceptable to you? Yes __ No __ . If you have checked "No", please identify how you prefer to be contacted: _______ _

Email Address:Q..~.O...C.-9I.\c..-.l..;.1.0q@;.»\$)().C!:J.M Employer Name Y 'Mt~ ~£ ~I'\ JOo."'v"'i'" Cm.V\\-") Employer Address (,1 '35 T",W\ 0' <:,~"V\\-e.t $I'ill-e,

Voter Registration: The City of Stockton requires members of the City Council Salary SeWng Commission, Civil Service Commission/Equal Employment Commission, and San Joaquin County Mosquito and Vector Control District to be registered voters of the City of Stockton. Please fll1 out the information below if you are applying for one of these positions so that your voter registration may be verified: lA, . ,_ ,A 7:::. JJ /b;ltJl; Name: 'StJ\e.s\o GonZ:Ii\\e-z. J(-f'1..f2 :f"4--/k.;p-~............ -

'\' () u V \ J. uJflhdaW -(!t.?1h1 'fJN-6rl:;/l, ' \rJ-. -\ ((,1O/,11J.. n;V:e C/'n.5ideraft'vn,"

City: -"""==='-f't----/'I---

(Form adopted by City Council on 10·10·95; Revised 12/13/10) ::ODMAIGRPWISEICOS.CC.CC_Llbrary:125665.1

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City 01 Stockton APPLICATION CONTINUED Page 2 015

Please state the reason you would like to be a member of this boardlcommlsslon:

,

APPLICANT NAME

Have you served on an adVisory group before?lli-If yes, please explain: ________________ _

How did you hear about the position? --"Q..,-""-,,(\"'.,,,,·,-I J..I __________________ _

City Council Policy 100-2 stales Ihat boardlcornmlssion members are required to attend meetings on a regular basis. If appoint~d, will you be able to allend meelings regularly and devote the time necessary 10 fulfill your duties as a mernber? Yes" No __

Do you or imrnedlale family members have any relationship (professional, financial, olher) that may presenl a polenllal conflict of Interest for Ihis advisory group? Yes __ No ~ If yes, please explain _________________________________ _


o 49-99 Cooperative Library System Advisory Board You musl be a resident of San Joaquin County, bul not the City of Lod!. Do you meel this requirement? 0 Yes 0 No

o Stockton Arts Commission Outside of your profession indicate what type of Arts you are active In (circle any that apply): Music, Dance. Theater, Cinema, Photography, Architecture, Art Criticism, Textile Arts, Literary Arts, the Visual Arts, Including (but not limited to) the Public or Environmental Arts, Graphic Arts, Design, Drawing, Painting, Prlnlmaking, Sculpture, Ceramics, and Art History Are you Inleresled In or accomplished In fund-raising? 0 Yes 0 No

o Building and Housing Board of Appealsl Handicapped Access Board of Appeals Do you have experience in any of the following areas (circle any that apply): General Building Conlraclor, Plumbing Conlraclor, Eleclrical Conlraclor, or Mechanical Conlraclor; Engineer or Archilect. Are you a disabled citizen? 0 Yes 0 No

o Central Parking District Advisory Board Do you own real property or are you an execulive officer of a corporalion Ihal owns real property wilhin Ihe Central Parking District? 0 Yes 0 No Specify property address(es): ___________________ _

o Climate Action Plan Advisory Committee Do you aclively represent any of Ihe following inlerest groups within the City of Stocklon (circle any Ihal apply): Environmental, Non-Profit Communily Organizalion, Labor, Business, Developer

o Cultural Heritage Board Are you knowledgeable have experience in, or exlensive background in any of the following areas (circle any thai apply): Historic or cullural tradilions of the communily, preservation, archlteclure, conslruction lechnology, real-estate, conslrucllon Industry, California licensed Archilect, Historian, Stocklon residenl for 40 years or longer.

o Devolopment Oversight Commission Do you work In Stockton orwilh a firmlorganization Ihat does business in Siocklon? 0 Yes 0 No State name/address of firm/organization: Are you any of Ihe following (check any th-a7t -ap-p"'"ly""')-----------------------o Local architecVdesigner 0 Local Civil Engineer 0 Mixed Use Builder/Developer o Local Represenlative from public at-large 0 Local Non Profit BuliderlDeveloper o Port of Siockion Execullve (CEO or Designee) 0 San Joaquin Partnership Executive (CEO or Designee) Building Industry Association 0 Execulive (CEO or Designee) Q[ 0 Mixed Use Builder/Developer Builder's Exchange 0 Executive (CEO or Designee) Q[ 0 General Conlractor

::ODMAIGRPWISEICOS.CC.CC _Llbrary:125665.1 . (Form adopled by Cily Council on 10-10-95: Revised 12-13-10)


o Port Commission

APPLICANT NAME

Do you reside wilhin the Port Dislrict boundary or consistent with the City General Plan boundaries, plus a one-half mile strip on either side of the Stockton Ship Channel from the Port to Disappointment Slough, if so for how long? ______ _

o Public Art Advisory Committee (circle any that apply) Employed as a professional visual artist, critic of contemporary visual art forums, or have knowledge of, or skill/experience In any of the following: activist for the visual environment, public art, regional/national Individual artists work, understanding of ethnic/gender diversity, the Stockton Public Art Plan processes and Implications for the City, decision-making ability, willingness to tolerate/promote change, new artistic & design expressions, community activities significant enough to confirm knowledge of issues and Individuals within the community. Must be a resident of Stocl<!on for at least 3 years.

0' San Joaquin Regional Transit District Board / Have you resided within the Transit District i!<Jundaries for at least one year? -0 Yes 0 No Are you a resident in the City of Stockton? iii Yes 0 No

o sports Commission (circle any that apply) . If you are not a resident of Stockton, do you own andlor operate a business within the City or are a sponsor or associated with a sports related event, name of business or event(s): _____________________ _

iJ Stockton Measure W Oversight Committee ~ .J Do you reside within Stockton's geographic boundary? Yes 0 No Are you at least 28 years of age? ~ Yes 0 No Are you an employee of any vendor, contractor or consu tant doing business with the City of Stockton? M Yes 0 No

o Council Water Advisory Group Do you reside within one of the Stockton Municipal Utilities' three utility service areas? 0 Yes 0 No If so, state which one: ________________ _

o Youth Advisory Committee (fill in, circle, or check) High school enrolled in: Will you be a senior next committee term? OYes ONo Are you a member of one of the following Community Centers? McKinley, Seifert and Selrra Vista, Strlbley and Van Buskirk,

other: -=---=~-c-;--;--c:-::-_:T,-,===:;_:;__; Which Council District do you reside in? District 1, 2, 3, 4, 6, or 6 (leave blank if you do not know).


WORK EXPERIENCE: List names, addresses, and dates of employers for the last five (6) years. Attach additional sheets of paper if needed.

FROM: MO. ~ DAY YEAR ,,)011 EMPLOYER NAME Y M.c P. ~ S~'/'. :Io"-,)",i", Ct.\.\V\ +-j TO: MO. II DAY YEAR,;)O ld-. ADDRESS--;-_-:----cc--__ ----:-__ -;--__ _

DUTIES: J ""'" ~ ~ t (lliVet\,,>rMl"<l-- LoD di .... ",,\-v(' /;:A ~ 't fA(:ft ,....,J "-<.J.......

-*"'e M~ ..:k Fe''''''' Ie.. \ ; Y\ ~ \rI $c.h QO ~ •

FROM: MO._~_'___D,AY YEAR..iOlO EMPLOYER NAME B~~s t (',r\,$ U\l,,\,<R-l'fl>.c.j TO: MO. 'll DAY YEAR.lI> II ADDRESS_--:--____ --:-______ _

DUTIES: ,\-, lAW>- '" Qr"'O"""", L~<lA" oX "-",, ~ (f~ (h\-- S-lI\ ~~). BUSINESS ENTERPRISES: List business name, Including fictitious name and address of any business enterprises currently or previously owned or operated.

FROM: MO. __ DAY ___ YEAR ___ BUSINESS NAME ________________ _

TO: MO., ___ DAY __ YEAR __ ADDRESS __________________ _

::ODMAIGRPWISEICOS.CC.CC_Ubrary:125665.1 (Form adopted by City Council on 10·10-95: Revised 12-13·10)

ctty of Stockton APPLICATION CONTINUED Page 4 of 5

APPLICANT NAME

TYPE OF BUSINESS OR SERVICE RENDERED: _________________ _

A resume reflecting experience, community activities, or other qualifications not listed below may be attached in order to assist the Council In evaluating your application. (Optional)

EDUCATION: ~. ~'\l\ \\ \& S,C.btlP\ s,.\-oc.\:-.\-bl'\ I C h-&'~'~'() s ~\\i'~f' \'<\1I1'lb.y> I CI\.

CONFLICT OF INTEREST: State and local law requires that you abstain from participation in decisions that may affect your financial interests, including sources of Income and interest In real property or investments. In addition, If appointed you may be required to fill out a disclosure statement that identifies certain of your financial interests beginning with the Immediate twelvemonth period prior to your appointment. Based on your best judgment, does this board or commission make decisions that may affect any sources of income, Interests in real property, or investments of you or your spouse?

Yes L No __ If yes, please explain. Identify any organizations, associations, corporations, or entities by which you are employed or associated that might be affected by decisions of this board or commission and the positions you hold .. __________________________________ _



If you are appointed to this Board/Commission/Committee, you may be required to file statements disclosing certain types of information so that the public can be made aware of potential conflicts of interest. The types of disclosure are:

Investments Interests in Real Property (other than your residence) Interests In Real Property Held by a Business Entity or Trust Investments Held by a Business Entity or Trust Income (other than loans and gifts) Income - Travel Payments, Advances, Reimbursements Income Gifts Business Positions Commission Income Received by Brokers, Agents, and Salespersons Income and Loans to a Business Entity or Trust Income from Rental Property

If you have any questions regarding disclosure requirements, please contact the City Clerk's Office at 937-8458.

CONVICTIONS: Conviction of a crime is not necessarily a bar to appointment. Each case is considered separately based on requirements of the position; however, failure to list convictions may result In disqualification.


nQ 2. List each civil action, if any, in which punilive or exemplary damages have been assessed against you, indicating in each

instance the date of the trial, court Judgment and the location of the ccurt which rendered the judgment:

~/(A . : :ODMAIGRPWISEICOS.CC.CC_Llbrary:125665.1 (Form adopted by City Council on 10-10-95; Revised 12-13-10)

City of stockton APPLICATION CONTINUED Page 5 of 5

APPLICANT NAME

I DECLARE, UNDER PENALTY OF DISQUALIFICATION AND TERMINATION, THAT ALL STATEMENTS IN THIS APPLI ATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLED r-. i

Date ---<1-,--1_' l..=' 5~---'-p ___ _

Please identify any specialized accommodations needed for equal participation: _____________ _

The following Information is voluntary and is gathered In accordance with State andjederallaws for the purpose of evaluating the effectiveness of our Affirmative Action and recruitment efforts. Please check: _V_Male Female

_White (Not Hispanic Origin) All persons having origins In any of the original peoples of Europe, North Africa or the Middle East

_Black (Not Hispanic Origin) All persons having origins in any of the Black racial groups of Africa .

....{H'lspanic All persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.

_American Indian or Alaska Native All persons having origins In any of the original peoples of North America and who maintain cultural identifications through tribal affiliation or community recognition. Please Identify your tribal affiliation.


_Asian

The Stockton City Council appoints members to the varioLis City of Stockton Boards and Commissions. The Council also appoints representatives to serve on various other San Joaquin County agencies as well. Please check the boxes below if you are interested in serving on any other boards/commissions. To find out about what these boards/commissions do and if you qualify, please visit the City of stockton website at www.stocktongov.com/commissions

049-99 Cooperative Library System Advisory Board

DArts Commission

gIluilding and Housing Board of Appeals

OCentral Park'lng District Advisory Board

!;iCity Council Salary Setting Commission

IQI'Civii Service and Equal Employment Commissions

OClimate Action Plan Advisory Committee

\1community Development Committee

O2lCultural Heritage Board

biDevelopment Oversight Commission

OHandlcapped Access Board of Appeals

[?r;,easure W Oversight Committee

OParl<s and Recreation Commission

::ODMAIGRPWISEICOS.CC.CC_Llbrary:125665.1

Q' Planning Commission

o Port Commission

o Public Art Advisory Committee

o Redevelopment Commission/Relocation Appeals Board

ri San Joaquin County Commission on Aging


OSan Joaquin Regional Transit District Board

OSports Commission

o Water Advisory Group

o Youth AdVisory Commission (must be In high school to serve on this Commission)

(Form adopled by Clly Council on 10-10-95; Revised 12-13-10)

ERNESTO A. GONZALEZ

1124 VIC'I'ORIAAVE,. STOCK'l'ON, CA 9$203 PHONE (925) 878-9476. [email protected]

EDUCATION

* Saint Maty's College of California: Moraga, CA

B.A. in Political Science

Graduated May, 2007

* St. Maty's High School: Stockton, CA

Graduated with honors (1998-2002)

WORK EXPERIENCE

* YMCA of San Joaquin County

Title: Youth & Government Coordinator

Supervisor: Mike Vann (209) 639-6814

(08/11 - Present)

* Boys & Girls Club of Tracy

Title: Program Leader

Supervisor: Rob Payne (173) 817-3731

(09/10 - 08/11)

* U.S. Census Buteau

Title: Enumerator

Supervisor: Matthew Widmark (310) 625-5547

(04/10 - 06/10)

* Gl'Ussroots Calnpaigns, Inc.

2365 Westwood Boulevard, Los Angeles, CA 90064

Title: Political FlUldraiser

Supelvisor: Patrick Dunigan (510) 666-7748

(10/09 - 03/10)

* 2010 Gavin Newsom Fot Govetuor Campaign

Title: Intern

Supelvisor: Lenny Young (323) 743-3175

(8/09 - 11/09)

* Macy's Department Store

341 Sun Valley Mall, Concord, CA 94520

Title: Loss Prevention Agent

Supervisor: Dan O'Regan (925) 689-3333 ext.4155

(2/08 - 5/08)

* Delta Hawkeye Security Services

3201 W. Benjamin Holt Dr., Stockton, CA 95219

Title: Secudty Guard

Supervisor: Kevin Faulkner (209) 670-3147

(9/07 - 2/08)

* Lafayette Academy

1400 Moraga Way, Moraga, CA 94556

Title: Tutor

Supervisor: Sarah Dickson (925) 376-0747

(8/06 - 7/07)

* Ditect Security

1036 W. Robinhood Dr., Stockton, CA 95207

Title: Security Consultant

Supervisor: Matt Torres (209) 477-6612

(6/06 - 9/06)

* Saint Mary's College Bookstore

1927 St. Mary's Rd., Moraga, CA 94575

Title: Cashier/Stocker

Supervisor: Clint Stroud (510) 593-6028

(1/05 - 12/05)

* Attistic Ir011

2228 Wilson Way, Stockton, CA 95207

Title: Assistant Manager

Supervisor: Ernesto Gonzalez, Sr. (209) 598-7700

(5/04 - 9/04)

* Bob's at the Marina

6639 Embarcadero Dr., Stockton, CA 94207

Title: Cook/Waiter

Supervisor: Bill Mattllews (209) 957-3279

(Summer 2002, 2003)

, .

ACTIVITIES/AWARDS

* Volunteered at Saint. Maryls College \'V'omen's Resource Center.

* Volunteered at the Elizabeth House in Oakland, CA.

* Member of the South Stockton Lions Club

* Member of the YMCA of San Joaquin County Dream Team Volunteer Group

SKILLS/ABILITIES

* Certified bartender.

* Mixed martial arts background.

* Fantastic customer seivice and communication skills.

* Basic computer skills, including Microsoft Word and Excel.

* Expedence woddngwith children in daycare/pdvate care/tutoring environments.

.

CITY OF STOCKTON

-II~I := ~ fijfP

APPLICATION FOR APPOINTME AND BACKGROUNP INFORMATION FOR


1) Please provide all infOlmation requested. 2) Please print or type all entnes In black or blue ink only. 3) Any atlachments must be single sided, 8 11, X 11 paper. 4) Information contained on this lonn is public record. 5) With the exception of the infonnation contained on this first page, all other Infonnation contained In this application may be

posted on the City's website for public view. 6) Submit completed application to: Office 01 the City Clerk, City Hall 1st Floor, 425 North EI Dorado Street, Stockton, CA

95202; Phone: (209) 937-8459

BOARD/COMMISSION/COMMITTEE NAME: PI.llning Commlslon ~ tt/.it(J-L-Complete Supplemental Question Ire, if applicable

Applicant NamE': KeaUs, Michael William Last

rI Home Address: 1702VeronosoWfi'/. Stoci<IQ!l. CA05207

Street Address City

First Middle

State Zip Mailing Address (il different than home address) _________________________ _

Preferred Contact Phone ( ) _5c.1c.8._91""O_5 _________ Alternate Phone (

Business Phone ( )473-1800 Fax ( ) 473-1881

I deciare under penalty of disqualification/termination that I have been a resident at the above address for c.1-,m",o""n",th:;--;-c_,--_ (length of time)

Resident of City Council District No.: _3 __ Are you an incumbent? Yes __ No _X __

The City of Stockton uses email as the preferred method of communication regarding your application. Is this acceptable to you? Yes _x__ No __ . If you have checked "No', please identify how you preferto be contacted: _________ _

Email Address: . .:.m ... k ... @.-k ... ea::.:ti ... s .... n ... et ____________ _

Employer Name ,eS::":clf"'Em=pl"'oyc:e.::d ____________________________ _

Employer Address 441q_~_P~rs~i!lnJ\,ve Ste C1, Stockton, CA 95207

Voter Registration: The City of Stockton requires members of the City Council Salary Setting Commission, Civil Sewiee Commission/Equal Employment Commission, and San Joaquin County Mosquito and Vector Control District to be registered voters of the City of Stockton. Please fill out the information belowifYOU are applying for one of these positions so that your voter registration may be verified: .' ..,;/ ... . /1"7-

Name: Mh;hael Keatls ..2.~,2Y~/? ,/~k.... l;jOLt ~

Address: 1702 Veronese Way

City: Stockton Zip Code: 95207

Signature; .. i>"'''-?.L''-''====--------------

(Fonn adopted by City Council on 10·10-95; Revised 12/13(10) C;\Documenls and Setungs\bhunter.CITYOFSTOCKTON\My Documents\125665-1.dac

20o, 1999


Please state the reason you would like to be a member of this boardlcommission:

APPLICANT NAME

t ImvnUved III Siockion (Of !iva yl>-'llll alIi! woukjcn!oy cOillribuUng DDmllUilnlllo Ihll.:it)' I !l<IIIIJOffiQ, this ell)' IIIIn dullp finllm;l~ltNlublu, lax rovcnu()!j llwdllMi, lind "'oI~Jlt Oimlll!>\lp.!N1J havQ nillho fJrilblflm5" M

Have you served on an advisory group before? ~ If yes, please explain: _________________ _

How did you hear about the position? _______________________ _

City Council Policy 100-2 states that boardlcommission members are required to attend meetings on a regular basis. If appointed, will you be able to attend meetings regularly and devote the time necessary to fulfill your duties as a membar? Yes • No

00 you or immediate family members have any relationship (professional, finanCial, other) that may present a potential conflict of Interest for this advisory group? Yes ___ No _" __ Ifyes, please explain __________________________________ _

SUPPLEMENTAL QUESTIONNAIRE: Please complete the following If applying for a vacancy on any of these listed boards/commissions/committees:

o 49-99 Cooperative library System Advisory Board You must be a resident of San Joaquin County, put not the City of Lodi. Do you meet this requirement? 0 Yes 0 No

o SIockton Arts Commission Outside of your profession Indicate what type of Arts you are active in (Circle any Ihat apply): Mu"iG, Dance. Theater, Cinema, Photography, Architecture, Art Criticism, Textile Arts, Literary Arts, the Visual Arts, including (but not limited to) the Public or Environmental Arts, Graphic Arts, Design, Drawing, Painting, Prinlmaking, sculpture, Ceramics, arid Art History Are you interested In or accomplished in fund-raising? 0 Yes 0 No

o Building and Housing Board of Appealsl Handieappod Access Board of Appeals Do you have experienCe in any of Ihe following areas (circle any that apply): General Building Conlractor, Plumbing Contractor, Electrical Contractor, or Mechanical Contractor; Engineer or Architect. Are you a disabled citizen? 0 Yes 0 No

o Cenlral Parking District AdvisorY Board 00 you OWn real property or are you an executive officer of a corporation that o'M)s real property within the Central Parl<ing District? 0 Yes 0 No Specify property address(e.): _~_~ _________________ _

o Cllma!e Acllon Plan Advisory Committee 00 you actively represent any ofthe following interest groups within the Cily of Stockton (circle any that apply): Environmental, Non-Profit Community Organization, Labor, Business, Developer

o Cultural Heritage Board Are you knowledgeable have experience In, or extensive background In any of the following areas (circle any that apply): Historic or cultural traditions of the community, preservation, architecture, construction technology, real-estate, construction induslry, California licensed Architect, Historian, Stockton resident for 40 years Or longer.

o Development Ovel'$ight C<>mmission Do you work in StoeMon or with a firmlorganizatlon thaI does bUsiness in Slockton? 0 Yes 0 No State name!address of firmlorganization: ===,.-_______________________ _ Are you any of the following (check any that apply) o Local architect/designer 0 Locel Civil Engineer 0 Mixad Use BuilderlOeveloper o Local Represenlative from public at-large 0 Local Non prom BuilderlDeveloper o Port of Slockton EXecutive (CEO or Designee) 0 San Joaquin Partnership Executive (CEO or Designae) Building Industry Associ.tloh 0 Executive (CEO Or Designee) ill 0 Mixed Use Builder/Developer Builder's Exch.nge 0 Executive (CEO or Designee) .QI 0 General Contractor

C:\Documenls and Selllngs\bhunter,CITYOFSTOCKTON\My Documenls\125665~1.doc (Form adopted by City Councll on 10--10-95: ReVised 12-1~-10)

City of Stockton APPLICATION CONTINUED P£!ge 3 of 5

o Port CommIssion

Michael Keatts

APPLICANT NAME

Do you reside within the Port District boundary or consistent with the City General Plan boundaries, plus a one-half mile strip on either side of the Stockton Ship Channel from the Port to DisappoinIllIent Slough, if so for how long? ______ _

o Public Art Advisory Committee (circle any that apply) Employed as a professional visual artist, critic of contemporary Visual art forums, or have knowtedge of, or skill/experience In any of the following: activist for the visUal enVironment, public art, regional/natIonal Individual artists work, underslanding of ethnic/gender diversity, the Stockton Public Art Plan processes and Implica~ons for the City, decision-making ability, willingness to tolerate/promote change, new artistic 8, design expressions, community activities Significant enough to confirm knowledge of Issues and individuals wilhin the community, Musl be a resldenl of Stockton for at leo,t3 years,

o San Joaquin RegIonal transIt District Board Have you resided wilhin the Transil District boundaries for at least one year? 0 Yes 0 No Are you a resident In Ihe City of Stockton? 0 Yes 0 No

o Sports CQmmisslon (circle any Ihat apply) If you are not a resident of Stockton, do you own andlor operate a business within Ihe City or are a sponsor or associated with a sports relaled evenl. name of business or event(s): ~~ _______________ ~~ __ _

o Stockton Measure W Oversight Committe. Do you reside within Siockton's geographic boundary? 0 Yes 0 No Are you alleast 28 years of age? 0 Yes 0 No Are you an employee of any vendor, conlractor or consultant doing business wilh the Cily of Siockton? 0 Yes 0 No

o Council Water AdvIsory !3roup Do you reside wllhin one ofthe Siockton Municipal Utilities' three utility service areas? 0 Yes 0 No If so, state which one: ________________________ ~~~ __ _

o youth AdVisory Committee (fill in, circle, or check) High school enrolled in: Will you be a. senior next commiHee term? DYes DNa Are you a member of one of Ihe follOWing Community Centers? McKinley, Seifert and SeilTa Vista, Stribley and Van Buskirk, other: Which--oCc-o-u-nc"il'"'D"is"""'t"ric"t-Cd:""0"-y-'ou-re-s'"'idc-e7in-;?~Dc-is-;-trC-ict-;-1;-,-:'2, 3, 4, 5, or 6 (leave blank if you do not know),


WORK EXPERIENCE: Lisl names, addresses, and dales of employers for the Jast five (5) years, Allach additional sheets of pap~r if needed,

FROM: MO,_O_6 __ 0, Ay_0_1 ___ YEAR 2011 EMPlOYER NAME Cavazos Law Firm

TO: MO, DAY YEAR __ --'ADDRESS 501 W Weber Ave Ste 300A, stockton 95203

DUTIES: Certified Law StUdent/Law Clerk - Prep'lre motions and petitions for clients for consideration by the courts.

FROM: MO, ___ O.AY ____ YEAR ___ ,EMPLOYER NAME~ __________ _

TO: MO, DAY YEAR ADDRESS ______________ _

DUTIES: _____________________________ _

BUSINESS ENTERPRISES: List business name, including fictitious name and address of any business enterprises currenlly or previously owned or operated,

FROM: MO,~ OAy_.D..:.1 __ YEAR 2007 BUSINESS NAME Colohial Home and Business Services

TO: MO, DAy YEAR __ ADDRESS 4410 N Pershing Ave Ste G1, Stockton, CA 95207

Real Estate, Mortgage, Insurance Agency C:\Oocurnents and SeUings\bhunler.CITYOFSTOCKToN\My Documenls\12q665·1.doC (Form adopted by City CounCil on 10-10-95; RevIsed 12-13-10)

> City of Stockton APPLICATION CONTINUED

Michael Keatts

APPLICANT NAME Page 40f5

TYPE OF BUSINESS OR SERVICE RENDERED: Real estate and insurance agenl

A resume reflecting experience, community activities, or olher qUalifications not lisled below may be attached in order to assist the Council in evaluating your application> (Optional)

EDUCATION: Juris Doctorate from Humphreys College, Laurence Drivon School of Law (2012),

California State University Hayward, Major in Information Systems Manag",ment (Senior level,not completed)

CONFLICT OF INTEREST; State and local law requires that you abstain from participation in decisions that may affect your financial interests, >including sources of income and Interest In real property or Investments, In addition, if appointed you may be required to fill out a disclosure statement that identifies certain of your fihBnclal interests beginning with the Irnmediate twelvemonth period priot to your appoinlment. Based on your best judgment, does this bO<lrd or commission make decisions that may effect any sources of income, interests in real property, or investments of you or yourspolise?

Ves ___ No _X __ If yes, please explain> Identify any organizations, associations, Gorporations, or entities by which you are employed or associated that might be affected by decisions of this board or commission and the positions you hold. ___________________________________ _

INFORMATION REGARDING CONFJJCT OF INTEREST AND "ILING OF STATEMENTS OF ECONOMIC INTERESTS

In accordance with Government Code Sections 87300 - 87313 and tMClty of Stockton's Conflict of Interest Code, this Board/Commission/Committee may be designated to file Statements of Economic Interests.

If you are appointed to this Board/Commission/Committee, you may be required to fila statements disclosing certain types of Information so that the public can be made aware of potential conflicts of interest. The types of disclosure are:

Investments Interests in Real Property (other than your residence) Interests in Real Property Held by a Business Entity or Trust Investments Held by a Business Entity or Trust Income (other than loans and gifts) Income - Travel Payments, Advances, Reimbursements Income Gifts Business Positions Commission Income Received by arokerS, Ag&nts,a.nd Salespersons Income anq Loans to a Business Entity or Trust Income from Rental Property

If you have any questions regarding disclosure requirements, please contact the City Clerk's Office at 937-8458,

CONVICTIONS: Conviction of a crime is nat necessarily a bar to appointment Each case is considered separately based on requirements of the position; however, failure to list convictions may result In disqualification>

1. Have you ever been convioted of a Felony? IF yes, please explain:

No

2> ~Ist eaoh ciVil action, if any, in Which punitive or exemplary d~mages have been assessed against you, if1dicatin~ in each instance the date of the trial, court Judgment and the location of the ,court which rendered the judgment: '

None C:\Documenls and SeUings\bhunler.CITYOFSTOCKTON\Wy DocUmenls\125G65~1.doc (Form adopted by City Council on 10-10-90; Revised 12.-13-10)

City of Stockton APPLICATION CONTINUED Page 5 of5

APPLICANT NAME

I DECLARE, UNDER PENAL TV OF,DISqUALIFICATION AND TERMINATION, THAT ALL STATEMENTS IN ,HI PPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE

~ Signature ."f:7'"'-:7"--''''--''---------- Date 1i1W20t2

Please identify any specialized accommodations needed for equat participation: -,,";:::00,,-' _____________ _

The following information is voluntary and is gathered in accordance with state and Fedarallaws for the purpose of evaluating the effectiveness of our Affirmative Acllon and recruitment efforts, Please check: _' __ Male_Female

_White (Not Hispanic Origin) All persons having origins In any of the original peoples of Europe, North Africa or the Middle East

_Black (Not Hispanic Origin) All persons having ortgins In any ofthe Black racial groups of Africa.


_American Indian or Alaska Native All persons having origins in any of the original peoples of North America and who maintain cultural identifications through tribal affiliation or community recognition. Please identify your tribal affiliation.

_Filipino All persons having origins in the Philippine IslandS.

_ASian

The Stockton City Council appoints members to the various City of Stockton Boards and Commissions. The Council also appoints representatives to serve on various other San Joaquin County agencies as well. Please check the boxes below if you are interested in serving on any other boards/commissions. To find out about what these boards/commissions do and if you qualify, please visit the City of Stockton website at www.stocktongov.com/commissions

049-99 Cooparative Library System Advisory Board

DArts Commission

DBuilding and Housing Board of Appeals

DCentral Parking District Adviso)), Board

DCity Council Salary Setting Commission

~Clvil Service and Equal Employment Commissions

DClimate Action Plan Advisory Committee

DCommunity Development Committee

DCullural Heritage Board

DDevelopmen! Oversight Commission

DHandlcapped Access Board of Appeals

DMeasure W Oversight Committee

DParks and RecrsaUon Commission

o Planning Commission

D Pori Commission

D Public Art Advisory Committee

D Redevelopment CommissionlRelocalion Appeals Board

D San Joaquin County Commission on Aging

D San Joaquin County Mosquito And Vector Conlrol Olstrict

IIISan Joaquin Regional Transit District Board

DSports Commission

D Water Advlso)), Group

o Youth Advisory Commission (must be in high sohool to serve on this Commission)

'C:\Documenls and Sellings\bhunler.CITYOFSTOCKTON\My Docurnents\125665·1,doc (Form adopted by City Council on 10~10-95; Revised 12~ 13-10)

, .,

NOV - 72012

APPLICATION FOR APPOINTMENT· AND BACK(;ROUND INFORMATION FOR


. 1) Please prOVide all information requested, 2) Please print ortvpe all entries in black or bl.ue Irlk only, 3) Any attachments must be single sided, 8 Y, X11 paper, 4)' Informat1on contained on this form is public record, 5) With the exception of the Information contained9n this first page, all other Information contained In this appliCation may be

posted on the City's website for public view, .' 6) Submit completed application to: Office olthe City Clerk, City Hall 1st Floor, 426 North EI Dorado Street; Stockton, CA

95202; Phone: (209) 937-8459

~ tocktan

BOARD/COMMISSION/COMMITTEE NAME: Planning Commission . '~b~o-m~p~le~re~s~u~p~PI~e~m~em~al~Q~u-e~sti~'o-n-na~ir-e~,i~fa-p~p~lica-'>~~e------~

Applicant Name: ..:.K::.ot::.so"'gc.:io-:;u-=.-____ ~----__ --------rC;;:hn::;'s:__-----~7,;;::rr.::__----~----~-----Last First. Middla

Home Address: ..: .. "'''o='''=''"''"'''~'''PI''= ________________ ---'S.;;I'''''",'''" ~ ________ ",c"c' .--___ '".5s;:207'---, __ --------~-street Address City State Zip

Mailing Address (if different than home address) ___________________________________ -'--_~

Preferred Contact Phone ( ) _2_09_2~. ·O-'-o_O"'lZ.c.4 __________ AIternate Phone (

Business phone ( ), __ -'--_--~------~- Fax (

I declare under penalty of disq~~e$Plion that I have been a resident at the above address for

Resident of City COU1ci! Dlstrlct N~ 7' Are you an Ino.umbent? Yes ____ . No_X_

3 years

(length of time)

The City of lltockion uses emaii as the preferred method of communication regarding, your application; Is this acceptable to YOU? Yes _x_ No __ , If you have checked "No", please Identity how you prefer to be cohtacted:, '. .

Email Address: cipkotsoglou@grnail'oom

Employer Name ,bowntow,n stookton N.llance .

EmPloyer Address 343 E Main St First Floor, Stockton, GA 95202

. Voter RegistratiQI1:The City of Stockton requires memb$rs ofihe (iity CounCil Salary Setting Commission,Givil Service CommiSsion/Equal Employment Commission, and San Joaquin County Mosquito and Vector Control Districlto be registered voters ofthe City of Stockton, Please fill out the information beloW if you are applying for one of these positions 60 that your voler registration may be verified:

Nanie: Cht1sKot$09ioU

Address: 6426 LMSburg PI

C. ~ty: -,SW::,. ::o:::~o:.:n'-m1··'-··7· ".'. -====:::= .• =7;. _ Zip Code: -'-9..:.;52.c.0.:..2..:.. ____ ~ Slgnatur_!:.e:,..ettF~+-+-------'-~--~ ____ ~-'--____ _

(Fomfadopted by Cily CounCil on 10-10,95; Revi;ed 12113110) . . . C:\Docurnents and Settingslbhunler.CITYOFSTOCKTON1Mv DOCtlmenls1125665'1 ,doc


ChTb Kol!l6glDu

Please state the reason you would like to be a member of this board/commission: N; fl Nfolong S!ooklon f6~1denl. 111m hlh'II'a~ln!:l in D~ltino morn Inyolved with the civl~ proooss.

APPLICANT NAME


How did you hear about the position? .::c::!.'".:::~:::"':::." ______________________ _

City Council Policy 100-2 states that board/commission members are required to attend meetings on a regular basis. If appointed, "1111 you be able to attend meetings regularly and devote the time necessary to fulfill your duties as a member? Yes x No __ _

Do you or Immediate family members have any relationship (professional, financial, other) that may present a potenlial conflict of interest for this adVisOry group? Yes __ No > If yes, pleaseexplain __________________________________ _


o 49-99 Cooperallve Library System Advisory Board You must be a resident of San Joaquin County, but not the City of Lodi. Do you meet this requirement? 0 Yes 0 No

o Stockton Arts Commission OUtside of your profession indicate what type of Arlsyou are solive in (circle any that apply): Music, Dance. Theater,Cinema, Photography, Architecture, Art Criticism, Textile Arts, Literary Arts, the Visual Arts, including (but nollimited to) the Public or Environmental Arts, Graphic Arts, Design, Drawing, Painting, Printmaking. Sculpture. CeramiC$, and Art History Are you interested In or accomplished in fund-raising? 0 Yes 0 No

o Building and Housing BOMd of Appeals/ Handicapped Access Board of Appeals Do you have experience in any of the following areas (circle any that apply): General Building Conlrllctor, Plumbing Contractor, Electrical Contractor, br Mechanical Contractor; Engineer or Architect. Are you a disabled citizen? 0 Yes 0 No

o Centra, Parking 01.51rlot Advisory Board Do you own r!lal property or are you an exeCutive officer of a corporation that o'/ln~ real property within the Central Parking Dismet? 0 Yes 0 No . Specify property address(p-s): ___________________ _

o Climate Action Plan Advisory Committee Do you actively represent any Of the following interest groups within the City of Stockton (circle any that apply): EnVironmental, Non-Profit Community Organization, Labor, Business, Developer

o Cultura' Heritage Board Are you knowledgeable have experience in, orexiensive background in any of the following areas (circle any thai apply): Historioor cultural traditions 6f Ihe community, preservation, architecture, construction technology, real-estate, construction Industry, California IIc!lnsed Architect, Historian, Stocklon residenl for 40 years or longer.

o Development Oversight Commission Do you work in Stockton or with a firm/organization that does business in Stockton? 0 Yes n No State name/address affirm/organization: ===_-------______________ _ Are you any of the following (check any that apply) o Local archilecVdesigner 0 local Civil Engineer 0 Mixed Use Builder/Developer o Local RepresentatiVe from public at-large 0 local Non Profit Builder/DeVeloper o Port of Stockton Executive (CEO or Designee). 0 San Joaquin Partnership Executive (CEO or Designee) Building Industry AssQclatlon 0 Executive (CEO or Designee) Q[ 0 Mixed Use Builder/Developer Builder's Exchange 0 Executive (CEO or Designee) Q[ 0 General Contractor

C:IOocumenls and Sell'ngslbhunler.CITYOFSTOCKTON\My Oocumenls\125665-1,doc (Fonn adopted by cuy Council on 10'10-95; Revised 12-13-10)

City of Stockton APPLICATION CONTINUEO Page 3 of5

Chris Kotsoglou

APPLICANT NAME

o Port Commission 00 you reside within the Port Oisbict boundary or consistent with the City General Plan boundaries, plus a one-half mile strip on.ei\her sl~e oUhe Stockton Ship Channel from the Port to Disappointment Slough, if 60 for how long? ______ _

o Public Art Advtsory Committee (circle any that apply) Employed as a professional visual artls~ critic of contemporary visual art forums, or have knowledge of, or skill/experience in any of the foil owing: activist for the visual environment, pUblic art, regional/national individual artists work, understanding of ethnic/gender diversity, the Stockton publiC Art Plan processes and implications for the City, decision-making ability, willingness to tolerate/promote change, new artistic & destgn expressions, community activities slgnificent enough to confirm knowledge of issues and individUals Within the community. Must be a resident of Stockton for at least 3 years,

o San Joaquin Regional Transit Olslrlct Board Have you resided within the Transll District boundaries for at least one year? 0 Yes 0 No Are you a resident in the City of Stockton? 0 Yes 0 No

o Sports Commission (circle any fhat apply) If you are not a resident of Stockton, do you own andlor operate a business within the City or are a sponsor or associated with a sports related event, name of business or event(s): ___________________ _

o Stockton Measure W Oversight Committee Do you reside within StOckton's geographic boundary? 0 Yes 0 No Are you at least 28 years of age? 0 Yes 0 No Are you an employee of any vendor, contractor or consultant doing business with the City of stockton? 0 Yes 0 No

o Council Water Advisory Group Do you reside within one olthe Stockton Municipal Utilities' three utility service areas? 0 Yes 0 No If so, state which one: ______________________________ _

o youth Advisory Commtttee (fill in, circle, or checK) High school enrolled in: Will you be a senior nexlcommitleaterm? DYes DNa Are you a member of one of the follOWing Community Centers? McKinley, Seifert and Seirra Vista, Stribley and Van Buskirk, other: Which-:C"',,-u-nc-';i1"'0"'is'7tr7ic7t '7do-y-'-o-'-uccrc-es'7id7e-:in-:?"""0""is7'tr""ict:-:1C", --:'2, 3, 4, 5, or 6 (leave blank if you do not know).


WORK EXPERIENCE: List names, addresses, and dates of employers for the tast five (5) years. Attach additional sheets of paper If needed.

FROM: MOOct DAY 1st YEAR 2010 EMPLOYER NAME Downtown Stockton Alliance

TO: MO, Present DAY YEAR ADDRESS 343 E Main Sl First Floor, Stockton, CA 95202

DUTIES: All marketing and special events for the downtown district

FROM: MO. Jan DAY YEAR 201 0 EMPLOYER NAME University of the Pacific Athletics

TO: MO. Present DAY YEAR AOORESS,_3 ..... 6_0_1_P_a_cl'-flc_A_v_e_~ ______ _

DUTIES: Media relation!), radio and public address announcing.

BUSINESS ENTERPRISES: List business name, including fictitious name and address of any business enterprises currently or previously owned or operated,

FROM: MO. __ DAY YEAR BUSINESS NAME' _______________ _

TO: MO. OAY __ YEAR __ AOORIOSS _________________ _

C:IOocuments and Setilngslbhunter.CITYOFSTOCKTONIMy Pocumenls\125665-1.doc (Form adopled by City Council on 10-l0-US; ReVised 12-13.101

City of Stockton APPLICATION CONTINUED Paga4 of 5

Chris Kotsoglou

APPLICANT NAME

TYPE OF BUSINESS OR SERVICE RENDERED: __________________ _

A resume renecting experience, community activilies, or other qualifications not listed below may be attached in order to assist the COlJncii in evalualing your application. (Optional)

EDUCATION: SA-University of the Pacific

CONFLICT OF INTEREST: State and local law requires that you abstain from participation In decisions that maY affect your financial interests, Including sources of Income and interest In real property or Investments. In addition, if appointed you may be required to fill ollt a disclosure statement that Identifies certain of your financial Interests beginning with the immediate twelvemonth period prior to your appointment. Based on your best judgment. does this board or commission make decisions that may affect any sources ofincome, interests in real property, or investments of you or your spouse?

Yes _X_ No __ If yes, please explain. Id~nlify any organizations, associaUons, corporations, or entities by which you are employed or associated that might be affected by deCisions of this board or commission and the positions you hold, CUU'lInt OJJlPioym-~ lhe Downtown StooklOn AUIa~oo.


In accordance with Government Code Section!; 87300 - 87313 and thll City of Stockton'!; Conflict of InterQst Code, this Board/Commission/Committee may be designated to file Statements of Economic Interests.

If you are appointed to this BOllrd/Commission/Committee, you may be required to file statements disclosing certain types of information so that the public can be made aware of potenilal conflicls of Interest. The types of disclosure are:

Investments Interesls in Real Property (other than your residence) Interests in Rllel Property Held by a Business Entity or Trust Investmants Held by a Business Entity or Trust Income (other than loans and gifts) Income - Travel Payments, Advances, Reimbursements Income Gifts Business Position!! Commission hlCOme Reooivod by Brokers, Agenls, and Salespersons InCOme and Loans to a Business Entity or Trust Income from Rental Property

If you have any questions regarding disclosure reqUirements, please contact the City Clerk's Office at 937-8458.

CONVICTIONS: Conviction of a crime is not necessarily a bar to ~ppoinlment. EaOh case is conSlejered separately based on requirements of the position; however, failure to list convictions may result In diSQualification.


No

2. List each civil action, If any. in which punitive or exemplary damages have been assessed against you, indicating in each inslance the date ofthe trial. court judgment and the location of the court which rendered the judgment:

C;\Documenls and Setllngs\bhunler.CITYOFSTOCKTONIMy Documenls\125665-1.doc (Fonn adopled by City Council on 10-10·95; Revised 12· 13-10)

City of stockton APPLICATION CONTINUED Pagll50f5

APPLICANT NAME

I DECLARE, UNOER PENALTY OF DISQUALIFICATION AND TERMINATION, THAT ALL STATEMENTS THIS APPLICATION ARE TRUE AND COMPLETE TO THE BE:ST OF MY KNOWLEDG

Signature_+--'---\,"'l-''r-________ _ Date /0 - 1/.J. - I 1..

Please Identify any specialized accommodations needed for equal participation: ______________ _

The following information is voluntary and is gathered In accordance with State and Federal laws for Ihe purpose of evaluating the effectiveness of our Affirmative Action and recruitment efforts, Please check: __ Male Female

_White (Not Hispanic Origin) All persons having origins in any of the original peoples of Europe. North Africa or the Middle East

_Black (Not Hispanic Origin) All persons having origins in any of the Black racial groups of Africa.

_Hispanic All persons of Mexican. Puerto Rican, CUban, Central or South American or other Spanish culture or origin, regardless of race.

_American Indian or Alaska Native All persons having origins in any of the original peoples of North America and Who maintain cultural Identifications through tribal afji'lation or <;Olllmunity recogniliQn. Please Identify your trtbal affiliation.

_FIlipino All persons having origins in the Philippine Islands.

_Asian

The Stockton City Council appoints members to the various City of Stockton Boards and Commissions. The Council also appoints representatives to serve on various other San Joaquin County agencies as well. Please check the boxes below if you are interested in serving on any other boards/commissions. To find out about what these boards/commissions do and if you qualify, please visit the City of Stockton website at WWw,stocktongov,Qom/commissions

049-99 Cooperative library System Advisory Board

IIIArts Commission

OBulldlng and Housing Board of Appeals

OCentral Parking District AdviSOry Board

OCity Council Salary Setting Commission

OCivliService and Equal Employment Commissions


OCommunity Development Committee

IIICuliural Heritage Board

ODevelopmenl Oversight Commission

OHandicapped Access Board of Appeals

OMeasure W Oversight Commillee

IIIParks and Recreation Commission

III Planning Commission

III Port Commission

o public Art Advisory Committee

III Redevelopment Commission/Relocation Appeals Board

o San Joaquin County Commission on Aging


IIISan J\>aquin Regional Transit District Board

OSports Commission

o Water Advisory Group

o youth Advisory Commission (must be in high school to serve on this Commission)

C;IDocuments and SeIUngslbhunter.CITYOFSTOCKTONIMy Documents\125665·'.doc (FOn11 adOPted by City Council on 10-10-95: Revised 12· 13-10)

Chris Kay (Kotsoglou) 6426 Leesburg Place. Stockton, CA 95207 Pllone: 209.200.0lZ4' ll-Man: [email protected]. twitter: @chrls.the..greek

Ellperience

Downtown Stockton Alliance· Marketing Manager Nov. 10lO·Present

•

•

•

•

•

•

Handled all marketing from media releases to enllre adverlising campaigns that would Include TV appeal'ances, scripting radio commercials and conducting interviews, creation and placement of online and print ads, and trade partnerships to generate free or in-kind trade advertiSing opportunities and market research to improve marketing outreach,

Managed Taste llfSart Joaquin, a BBQ competition that drew over BOOO visitol'S in 2011 and 9000 visitors in 2012 to Downtown Stockton, Ma.'keting plan generated over 2 million impressions through blitz of radio, TV, print and online advertising; Taste generated $60,000 in income; recruited over 30 vendors; managed staff of 20 and a volunteer team of over 100; personal oversight of our supply budget of over $20,000, and handled city permitting, which exceeded $151000. _Wj:\~\:\~J/~W:J)Jslt)1i.ft(llillill,1;ruH

Organized Stocktobe.'fest, an Oktoberfest-style beer celebration on the Downtown Stockton waterfront; responsibilities included setting up an organizing committee, permitting. vendaI' recruitment, staff plan. volunteer recruitment, and budget oversight 2011 grew from 700 visitors to over 050 and saw its highest revenue ever, ~!-'!~I}}!,~;U1dul )11J~d l.:S1.£:!JJll

Created ne\\advettiSing partnerships, such as in-game advertising during Pacific Athletic events to attract more college stut(ijl;1ts and outreach thI'Q\\gh Adelante Media Group to expand our customer base to include the large Hispanic nlanket in the area.

;,!f. Organization{f,(ils aWal'ded "Indusb'y Partne.· of the Year" by the Stockton Convention and Visitors Bureau, and a commendatioW'from the City of Stockton for Taste of San Joaquin,

Responsibilities also included creatillg regular staff report presentations to the BOD,assisting dowhtown stakeholders with special events and marketing needs, ami ]'ecruitlng events into Downtown Stockton,

Pacific Athletlcs·Media Relations/Radio and Public Address Announcer Jan. 2010.Prl!sl!nt

• Crafted media guides and media releases for Field Hockey and Men's Volleyball with InDesign and Photosbop,

• Game-day operations of creating programs, stat-keeping, post-game recaps, and video shooting and editing for distribution on the Pacific Athletics site,

• Radio play-by-play and public a!idress announcer for baseball, basketball, and volleybalL

• Created, edited and posted a weekly podcast. including lleWS, previews, and a weekly interview with one of the coaches,

YMCA·Sports Coordinator April 2006·Mar. 2009

• All marketing which included marketing strategies and mer design/distribution, as well as surveys to improve program and increase sport retention,

• Directed youth sports leagues, including registration drives, recruiting volunteers, ordering equipment, and budget management, as well as adding new programs such as basketball camps aad a wrestling program,

• Doubled the amount of participants in competitive basketball in less than one year, from 60 to over 150 through surveys and targeted marketing,

Education

University of the Pacific

San Joaquin Delta College

Skills

Microsoft Word, Excel and PQwerPoint

Adobe lnDesign and Photos hop

Fluentin Greek

Organizations and Philanthropy

Leadership Stoddon - 2012 - Present

BA-Communications

AA

• Participating in the program through the Chamber of Commerce to learn more about the local area • Class project coordinator fora StoeMon Image campaign called "I AM STOCKTON" • Participated in local events including ribbon cuttings and city council nieetings

Good Government Group - 2011- Present

• ReCl"lllted by Good Government Group as an active member of the community to participate on local elected or appointed boards

• Class on the Inner workings of government including government fee structure, School reqUirements, water issues, and transportation programs

• Volunteered on campaignS at fundraising events and walking precincts.

YMCA - 2008-2011

• Basketball Co.ch for 5th-8th grade boys basketball team

Downtown Stockton Alliance ~ 2009-2010

• Wrote articles on nightlife for the Downtowner • Led College Nights, a community outreach program to get Pacific Students into a revitalized downtown • Arranged protnotions with business and talent, while coordinating te,un in their assigned duties • Research project on the logistics of a tree planting program in Downtown Stoel,ton

City of Stockton - Spring 2010

• Organized and conducted focus groups to survey the community to find their budget priorities • Created lists and survey parameters for the focus groups • Trained lOoderators on how to conduct a successful focus group

Beyond OUI' Gates, University of the Pacific· 2010

• Media outreach and created media kits to distribute dul'ing the events • ldentilled and reached out to community lea<lers to participate in the program • Established and set up venues for the events • Recruited volunteer help

References

1. Susan Eggman, Stockton City Council District 5, State Assembly District 13 Candidate, Professor California State University, Sacramento Sllsall eg~nHIJI(?tly..i2lwll.cflm 2099378244

2. Wes Rhea, Executive Director, Stockton Convention and Visitors Bureau, Community Partner WC.\j(wvisitstor~tml,!1J.:g

2099862769

3. Emily Baime, Economic Development Director, Downtown Stockton Alliance, CUlTent Supervisor ~lmim~KihlQl~nt~!.Wl1stf,It:I{II')Il,()I'v,

6198401144

4. Ric Gilbert, Way Out West BBQ Organizer, Community Event Partner fih;Ii1l.3 .. .@11QiUli ril,cD1U 40R2191041

5. Jonathan Carlos, Sales Manager, Comcast Spotlight [email protected]!li Ca rins-{ilIGtbl (~,'"{)tll [.lSt. Q1.nl 9165001420

6. Wendy Brodnick, Professor, University ofthe Pacific )Y~.!J.dy.@hmdtlkkn)ln 2095985818

7. Dave Fr'edel'ickson, Visiting Professor, University of the Pacific; organizer, Beyond Our Gates program fH!:.~{trJjJJ.\:j£wfullt'ldjjL!tilH 202.6791000

:1

<:)'CITYOF STOCKTON

CITY CLEHI< APPLICATION FOR APPOINTME '!; CITY OF STOCKTON_

AND BACKGROUND INFORMATION FOR BOARDS, COMMISSIONS, AND COMMITTEES

1) Please provide ali information requested. 2) Please print or type ali entries in black or blue Ink only. 3) Any attachments must be single sided, 6 Y, X 11 paper. 4) Information contained on this form Is public record. 6) With the exception of the Information contained on this first page, ali other information contained In this application may be

posted on the City's website for public view. 6) Submit completed application to: Office oftha City Clerk, City Hali1st Floor, 425 North EI Dorado Street, Stockton, CA

95202; Phone: (209) 937-8459 SJ Transit District Board

BOARD/COMMISSION/COMMITTEE NAME:_B-;::oa_rd __ /c,...,om,-m..".is_sio";-n_,-;-;-.."........".---,...,-.,;,-,-,,.-,..,..-__ Complete Supplemental Questionnaire, if applicable

Applicant Name: -'M.;.;a;:cys"--;--,... ___________ =-.J.;.oh .... n_. ___ --;=7.W_II_lIs_m ________ _ Last First Middle

HomeAddress: ~16~2~9P~o~rle~rwF.~y~. __ ---_----~SI~~~hlo~n~._-----C~A~.~_-~95~2~~_-------Street Address • City State Zip

Mailing Address (If different than hOme address)

Preferred Contact Phone (

Business Phone (

) -,(2 ___ 0",-9,-) 4_7.,c.9_"2_75 __ 7 ______ Alternate Phone (

Fax (

I declare under penalty of disqualificationltermination that I have been a resident at the above address for ,.:2::,:w"'ee:;k;::s;;:-:== ........ (length of time)

Resident of City Council District No.: __ Are you an incumbent? Yes __ No _X __

The City of Stockton uses elllail as the preferred method of communication regarding your application. Is this acceptable to you? Yes _x __ No __ . If you have checked "No", please Identity how you prefer to be contacted: ________ _

Email Address:[email protected]

Employer Name Valley Christian Center

Employer Address ______________________ . ____ . ______ _

Voter Registration: The City of Stockton requires members of the City Council Salary SeHing Commission, Civil SalVica Commission/Equal Employment Commission, and San Joaquin County Mosquito and Vector Control District to be registered voters of the City of Stockton. Please fill out the information below If you are applying for one of these positions so that your voter registration may be verified:

Name: John W. Mays

Address: 1629 Porter Way

City: Stockton Zip Code: ,;:9=53::.;0:.;7 ___ _

Signature: 9~- IV 112:t'

(Follll adopted by City Council on 10-10-95; Revised 12113110) C:IOoculllents and Settlngslbhunter.CITYOFSTOCKTONIMy DocumentsI125665-1.doc


John WMays

Please state the reason you would like to be a member of this board/oommlsslon:

APPLICANT NAME

Illavo ~a~ad my I»mmUJl\ly lrom whara I roc;jnlly moved ~s boll! MayOl nn~ Mayor pro-Tom ItQIll2QOB ttl 2(l1a. I ali stlIVOU on tho MOlte~ County AsooolaUon 01 Govomm(mt for Silt yGI\f8 Mel Ute CItRlI 01 tho- SlIma from 2012·:lOn

I also was Commissioner of Merced Local Agenoy FormQ\l()1\ CommissIon 2006-2013 and ChaIr 201 0-2012.

Have you served on an advisOlY group before? ~ If yes, please explain: ________________ _

How did you hear about the position? ",W"",b,--_.

City Council Polloy 100-2 states that board/commission members are required to attend meetings on a regular basis. If appointed, will you be able to attend meetings regularly and devote the time necessary to fulfill your duties as a member? Yes x No

Do you or immediate family members have any relationship (professional, finanoial, otMr) that may present a potential oonflict of Interest for this advisory group? Yes ___ No _x __ Ifyes, please explain ____________________________________ _


o 49·99 Cooperative Library System Advisory Board You must be a resident of San Joaquin County, but not the City of Lodi. Do you meet Ihls requirement? 0 Yes 0 No

iii Stockton Arts commission Outside of your profession indicate whal type of Arts you are active In (Circle any Ihat apply): Muslo, Dance. Theater, Cinema, Photography, Architecture, Art Criticism, Textile Arts, Literary Arts, the Visual AltS, including (but not limited to) the Public or Environmental Arts, Graphlo Arts, Design, Drawing, Painting, Printmaking, Sculpture, CeramiCS, and Art History Are you interested In or accomplished In fund-raising? iii Yes D No

o Building and Housing Board of Appeals/ Handicapped Access Board of Appeals Do you have experience In any of the following areas (olrole any that apply): General Building Contractor, Plumbing Contractor, Electrical Contractor, or Mechanical Contractor; Engineer or Arohiteot. Are you a disabled citizen? 0 Yes D No

o Central Parking District Advtsory Board Do you own real property or are you an exeoutive officer of a corporation Ihat owns real property within the Central Parking Dlstlict? 0 Yes 0 No Speolfy property address(es): ______ ~ ___________ . __ _

o Climate Action Plan Advisory Committee Do you actively represent any of the following interest groups within the City of Stockton (oircle any that apply); Environmental, Non-Profit Community Organization, Labor, Business, Developer

o cultural Heritage Board Are you knowledgeable have experience In, or extensive baokground In any oftha following areas (oirole any that apply): Historio or cultural traditions of the community, preservation, arohlteoture, construction technology, real-estate, oonstructlon industry, California licensed Architect, Historian, Stocllton resident for 40 years or longer.

o Development Oversight Commission Do you work In Stockton or with a firm/organization that does business In Stockton? 0 Yes 0 No Slate name/address of firm/organization: _ Are you any of the following (oheck any that apply) o Local archltecVdesigner 0 Local Civil Engineer 0 Mixed Use Builder/Developer o Local Representative from public at-large 0 Local Non Profit Builder/Developer o Port of Stockton Executive (CEO or Designee) 0 San Joaquin Partnership Executive (CEO or Designee) Building Industry Association 0 Executive (CEO or Designee) ill D Mixed Use Builder/Developer Builder's Exchange 0 Executive (CEO or Designee) ill 0 General Contractor

c:\Oocuments and Setlings\bhunter.CITYOFSTOCKTON\My Documents\125665.1.doo (Form adopted by Coy Counoll on 10·10-95; Revised 12-13-10)

City of stockton APPLICATION CONTINUED Page 3 of6

o Port Commission

APPLICANT NAME

Do you reside within the Port Dlslrict boundary or consistent with the City General Plan boundaries, plus a one-half mile strip on either side of the Stockton Ship Channel from the Port to Disappointment Slough, If so for how long? ______ _

o Publlo Art Advisory COlllmlttee (circle any that apply) Employed as a professional visual artist, critic of contemporary visual art forums, or have knowledge of, or skill/experience In any of the following: activist for the visual environment, public art, regional/national individual artists work, understanding of ethnic/gender diversity, the Stockton Public Art Plan processes and Implioations for the City, decision-making ability, willingness to tolerate/promote change, new artistic & design expressions, community activities significant enough to confirm knowledge of Issues end individuals within the community. Must be a resident of Stockton for at le.st 3 years.

I2f San Joaquin Regional Transit District Board Have you resided within the Transit District boundaries for at least one year? 0 Yes QilNO Are you a resldentin the City of Stockton? IE! Yes 0 No

o Sports Commission (circh~ any that apply) If you are not a resident of stockton, do you own and/or operate a business within the City or are a sponsor 0'· associated with a sports related event, nama of business or event(s): _____________ ~ ________ .

Ii Stockton Measure W Oversight Committee Do you reside within Stockton's geographic boundary? JB(Yes 0 No Are you at least 28 years of age? .r:f Yes 0 No Are you an employee of any vendor, contractor or consultant dOing business with the City of Stockton? 0 Yes jgj' No

o Council Water Advisory Group Do you reside within one of the Stockton Municipal Utilities' three utility service areas? 0 Yes 0 No If so, state which one: ________________________ __

o youth Advisory Committee (fill in, circle, or check) High school enrolled In: Will you be a senior next committee term? DYes ONo Are you a member of one of the following Community Centers? McKinley, Seifert and Selrra Vista, Stribley and Van Buskirk,

other: ""'--=====::-:-.-:;..,..,.-;;-c==:--:;--; Which Council District do you reside in? District 1, 2, 3, 4, 5, or 6 (leave blank If you do not know).


WORK EXPERIENCE: List names, addresses, and dates of employers for the last five (5) years. Attach additional sheets of paper if needed.

FROM: MO. 07 DAY 25 YEAR 2005 EMPLOYER NAME Valley Christian Center

TO: MO. 07 DAY 28 YEAR 2013 ADDRESS 2658 Blossom Street Dos Palos Ca 93620

DUTIES: To develop a ministry of welcome and hospitality to all congregants and visitors.

FROM: Mo.11 DAY 06 YEAR 2006 EMPLOYER NAME City of Dos Palos

TO: MO. 07 DAY 20 YEAR 2013 ADDRESS 2174 Blossom Street Dos Palos CA 93620

DUTIES: Mayor and Mayor pro-Tem to create strategiC alliances/Pursue creative means of financing growth.

BUSINESS ENTERPRISES: List business name, Including fictitious name and address of any business enterprises currently or previously owned or operated.

FROM: MO.~ DAY 01 YEAR 201 0 BUSINESS NAME.;;.Jo;:;h.:.:n;:;n","y;:;A.:.:d=a~m;=s.:.:M;:;u::.:s::.ic=--______ _

TO: MO. 07 DAY ~ YEAR 2013 ADDRESS 1805 Blossom Street Dos Palos CA 93620

C:IOocuments and Setlingslbhunter.CITYOFSTOCKTONIMy OocumentsI125665-1.doc (Form adopted by City Council on 10-10-95; Revised 12-13-10)


APPLICANT NAME -

I DECLARE, UNDER PENALTY OF DISQUALIFICATION AND TERMINATION, THAT ALL STATEMENTS IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLE~~

Signature L ~<Q It:? ill ¥= Date,;:O"'7/0"'""'20"'13'--_______ _

Please Identify any specialized accommodations needed for equal participation: ~ _____ ~ ______ _

The following Information is voluntary and is gathered in accordance with State and Federal laws for the purpose of evaluating the effectiveness of our Affirmative Action and recruitment efforts. Please check: _X __ Male Female

~White (Not Hispanic Origin) All persons having origins In any of the original peoples of Europe, North Africa or the Middle East

_Black (Not Hispanic Origin) All persons having origins in any of the Black racial groups of Africa.


_American Indian or Alaska Native All persons having origins In any of the original peoples of North America and who maintain culturalldenllflcalions through tribal affiliation or community recognition. Please Identify your tribal affiliation.


_Asian

The Stockton City Council appOints members to the various City of Stockton Boards and Commissions. The Council also appOints representatives to serve on various other San Joaquin County agencies as well. Please check the boxes below if you are interested in serving on any other boards/commissions. To find out about what these boards/commissions do and if you qualify, please visit the City of Stockton website at www.stocktongov.com/commissions


IiIArts Commission

o Building and Housing Board of Appeals

DCentral Parking District Advisory Board

IiICity Council Salary Setting Commission

DCivii Service and Equal Employment Commissions

DClimate Action Plan AdviSOry Committee

DCommunity Development Committee

DCultural Heritage Board

IiIDevelopment Oversight Commission

DHandlcapped Access Board of Appeals

DMeasure W Oversight Committee

IiIParks and Recreation Commission

IiI Planning Commission

o Port Commission

IiI Public Art Advisory Committee


IiI San Joaquin County Commission on Aging

IiI San Joaquin County Mosquito And Vector Control District

IiISan Joaquin Regional Transit District Board

DSports Commission

IiI Water Advisory Group

o youth Advisory Commission (must be In high school to serve on this Commission)

C:IDocuments and Settingslbhunter.CITYOFSTOCKTONIMy DocumentsI125665-1.doc (Form adopted by City Council on 10.10-95; Revised 12-13-10)

City of Stoc:kton APPLICATION CONTINUED Page 4 of 6

JohnW Mays APPLICANT NAME

TYPIi! OF BUSINIi!SS OR SERVICIi! RIi!NDERED: ~/,-1!:.J1d""."".5,,"1, e-""-""£'-!.M""f(}..,:..p_·L-;("-'w::...171: ....... I<-L...=-____ _

A resume reflecting experience, community aotivities, or other qualifications not listed below may be attached In order to assist the Council In evaluating your application. (Optional) .

EDUCATION: Doctorate of Ministry from Friends International Christian University Merced CA

CONFLICT OF INTEREST: State and looallaw requires that you abstain from partiolpatlon in decisions that may affect your financial interests, including sources of Inoome and interest In real property or Investments. In addition, if appointed you may be required to fill out a disclosure statement that identifies certain of your financial Interests beginning with the immediate twelvemonth period prior to your appointment. Based on your bllst judgment, does this board or commission make deolslons'that may affeot any souroes of income, il1terests in real property, or Investments of you or your spouse?

Yes __ No ~ If yes, please explain. Identify any organizations, associations, corporations, or entities by which you are employed or associated that might be affected by decisions of this board or commission and the positions you hold. ___________________________________ .


In accordance with Government Code Sections 87300 - 87313 and the City of Stockton's Conflict of Interest Code, this Board/Commission/Committee may be deSignated to file Statements of Economic Interests.


Investments Interests in Real Property (other than your residence) Interests in Real Property Held by a Business li!ntity or Trust Investments Held by a BUSiness Entity or Trust Income (other than loans and gifts) Income - Travel Payments, Advances, Reimbursements Income Gifts Business PoSitions Commission IncoMe Received by Brokers, Agents, and Salespersons Income and Loans to a Business Entity or Trust Income from Rental Property

If you have any questions regllrding disclosure requirements, please contact the City Clerk's Office at 937·8468.

CONVICTIONS; Conviction of a crime Is nol neoessarlly a bar to apPointment. Each oase is considered separately based on requirements of the position; however, failure to list convlotlons may result In disqualification.


No

2. List eaoh civil action, If any, In which punitive or exemplary damages have been assessed against you, Indicating in each instance Ihe date of the trial, court judgment and the location of the court which rendered Ihe judgment:

C:\Documents and Settingslbhunter.CITYOFSTOCKTONlMy Documents\125665·1.doo (Form adopted by City Council on 10·10·95; Revised 12; 13·10)

Johnny Mays 1629 Porter Way Stockton CA 95207 Cell: 209-479-2757: Email: [email protected] Website: www.drjohnnymays.com

Executive Profile

1973 - 2013 Ordained Minister

I am an Ordained Assembly of God minister. As the Pastor with ministry oversight, I am committed to growth-effective management of resources and quality performance

• To promote Christ Teachings in all religious education programs. • To develop lay leadership in the congregation by encouraging all members to share their gifts

• To establish evangelistic outreach in neighborhood communities. • To develop a ministry of welcome and hospitality to all congregants and visitors.

• To promote Christ Teachings in all religious education programs.

Core Accomplishments 2013 brings me to forty years of ministry. During this time I have served the Lord as I felt He was leading me. This outreach to the world has taken me to every state in our great country and thirty nine countries the most recent China. I have served in various capacities from pastor, evangelist, church planter, school teacher and missionary. Twelve years as missionary/evangelist I spent a great deal of time in Russia, England and Africa. I work involved mentoring indigenous pastors and establishing churches and ministries in their communities. Right after Bible College I went to work for Sacramento Christian Schools of Sacramento. Later my wife Judy and I started Windsor Christian Academy. While still in Bible College I traveled with ministers and performed in every major prison in California and Nevada.

2005 - 2013 City/County Government

As Mayor and as Mayor pro- Tem I labored to create strategic alliances with church, civic, and other organization leaders to effectively align with and support key initiatives. Builds and retain high performance staff by hiring, developing and motivating skilled professionals. Pursue creative means of financing growth. My leadership was recognized countywide when the six mayors and five county supervisors of Merced County elected me as;

• Chairman of Merced County Association of Governments • Chairman of Merced County Waste Management Authority

• Chairman of The Joint Powers authority of Merced County • Chairman of the Local Agency Formation Commission (Two Terms)

• Chairman of Merced County Planning Commission

Professional Accomplishments: Accomplishments: Land purchases for water plant expansion, a new city hall, downtown restoration, new parks, more trees, efficient utilities, timely transportation enhancements, a new animal shelter, improved safety and handicapped access, new equipment and vehicles, developing real estate transactions, for a new shopping center, lead labor negotiator. All accomplished with grants and careful stewardship of the public's tax dollars.

Manager of KDPT Radio When I came to Dos Palos in 2005, I discovered there was a local community radio station. I introduced myself to the Board, desiring only to have a Sunday Morning Bible teaching program. After a few weeks the Board came to me and asks if I would consider managing the station and bringing it to another level. Drawing from my musical experience and a few old friends in the business I accomplished raising our listenership immensely. I started a local anchor program, changed the mix, and now we are most listen to LPFM station in our market.

Music and Entertainment Before I came into the ministry I worked as a professional musician. I performed on television and radio and in dance/show bands. In 1973 while performing with the Merle Haggard Show, I came to know the Lord and God called me into the ministry. Right away I started traveling with evangelists and playing in churches. In every church and ministry I have been a part of the worship and performed musical. I have recorded three CD's of Worship and Gospel music.

Skill Highlights

Church Management Small business development Leadership/communication skills Product development Self-motivated Employee relations Worship leader/musician Negotiations

Personal I have been married to my wife Judy forty three years, serving together in the ministry for forty years. Our family is five sons and one daughter, and many grandchildren. There are no children living at home.

Education Friends International Christian University Sacramento Bible College. Andrew Baptist College

Merced, CA Sacram ento CA Sacrament CA

1993 Doctorate of Ministry 1978 Masters Theology 1976 BA Christian Ed

These were all unaccredited church schools. However my education is filled with life and experience

, ~CITYOF ;;i1JSTOCKTON

APPLICATION FOR APPOINTMENT AND BACKGROUND INFORMATION FOR


1) Please provide all Information requested, 2) Please print or type all entries In black or blue Ink only, 3) Any attachments must be single sided, 8 11, X 11 paper, 4) Information contained on this form Is publlc'record,

A1JG ~ 42013

5) With the exception of the Information contained on this first page, all other Information contained In this application may be posted on the City's website for public view,

6) Submit completed application to: Office of the City Clerl<, City Hall 1 st Floor, 425 North EI Dorado Street, Stockton, CA 95202; Phone: (209) 937-8459

WATER ADVISORY GROUP; BOARD/COMMISSION/COMMITTEE NAME:_S<+J~R'--cE..,.G-:IO:-N--cA;-L_T--,R-;-A:::-N_S-;;-IT.,.D_I-:-ST--,'R,--I_CT-,,-;B.,-O_A_RD __

Com'plete Supplemental Questlcl'nnalre, If applicable

Applicant Name: McGaughey, John A. Last First Middle

Home Address: 3041 Oarousel Clro, Stool(ton, CA 95219

t~ Street Address Mailing Address (If different than home address) _______________________ _

state Zip City

Preferred Contact Phone (

Business Phone (

) ,.:9.:.:13:...·4.::8c::6-.:.6cc7"-64:..-_____ Alternate Phone (

Fax ( •

I declare under penalty of disqualification/termination that I have been a resident at the above address for .::2:.'miC0=.:n::th",s,==,,_ , (length of time)

Resident of City Council District No,: _4_ Are you an Incumbent? Yes __ No _X __

The City of Stockton uses email as the preferred method of communication regal'dlng your appllcalion, Is this acceptable to you? Yes _x__ No __ . If you have checl<ed "No", please Identify how you prefer to be contacted: ________ _

Email Address: prlmex-,2@~y",ah.:.:oc:o:.:.,c __ omcc.... ________ _

Employer Name Ridge Communloatlons, Ino.

Employer Address 12667 Alcosta Blvd" San Ramon, CA 94583

Voter Registration: The City of Stookton requires members of the City Council Salary Setting Commission, Civil Servloe Commission/Equal Employment Commission, and San Joaquin County Mosquito and Vector Control District to be registered voters of the City of Stockton, Please fill out the Information below If you are applying for one of these positions so that your voter registration may be verified:

Name: John A. MoGaughey

Address: 3041 Carousel Clr,

City: Stockton

"':M2-':'-y----Zip Code: ..:9..:.52",1c:9 __ _

(Form adopled by Clly Council on 10·10·96; Revised 12/13/10) C:\Documents and Settlngs\bhunter,CITYOFSTOCI<TON\My Documents\126666·1,doc

, City of Stockton APPLICATION CONTINUED Page 2 of 5

John MoGaughey

APPLICANT NAME

Please state the reason you would like to be a member of this board/commission: I want to serva my oommunlly. Thle 10 an oulstandlng opportunny for rna to demonstrate my valuable sllliis and knowledge and 1'1111 hopefully allow me \0 make a

meaning/ul oontributlon towo.rd Improving lifo In Stooldon,

Have you served on an advisory group before? ~ 11 yes, please explain: ________________ _

How did you hear abodt the position? -'-N~'w"""'p'''_p.~r _____________________ _

City Counoll Polley 100-2 states that board/commission members are required to attend meetings on a regular basis. If appointed, will you be able to attend meetings regularly and devote the time necessary to fulfill yoU!' duties as a member? Yes x No

Do you or Immediate family members have any relationship (professional, financial, other) that may present a potential conflict of Interestfor thls'advlsory group? Yes __ No _x __ Ilyes, please explain _________________________________ _


o 49-99 Cooperative Library System Advisory Board You must be a resident 01 San ,Joaquin County, but not the City of Lod!. Do you meet this requirement? jjJ Yes 0 No

o Stockton Arts Commlsston Outside of your profession Indicate what type of Arls you are aotlve In (circle any that apply): Music, Dance. Theater, Cinema, Photography, Architecture, Art Crillclsm, Textile Arts, Literary Arts, the Visual Arts, Including (but not limited to) the Publlo or Environmental Arts, Graphic Arts, Design, Drawing, Painting, Printmaking, Sculpture, Ceramlce, and Art History Are you Interested In or accomplished In fund-raising? jjJ Yes 0 No

o Building and ~Iouslng Board of Appealsl Handicapped Access Board of Appeals Do you have experlenoe In any of the following areas (clrole any that apply): General Building Contractor, Plumbing Contractor, Electrical Contractor, or Mechanical Contractor; Engineer or Architect. Are you a disabled citizen? 0 Yes 0 No

o Central Parking District Advisory Board Do you own real property or are you an executive officer of a corporallon that owns real property within the Central Parking District? 0 Yes II No Specify property address(es): __________________ _

o Climate Action Plan Advisory Committee Do you actively represent any of tho following Interest groups within the City of Stockton (circle any that apply): Environmental, Non-Profit Community Organization, Labor, Business, Developer

o Cultural Heritage Board Are you l<nowledgeable have experience In, or extensive background In any of the following areas (circle any that apply): Historic or cultural traditions of tho community, preservation, architecture, construction technology, real-estate, conslructlon Industry, California licensed Architect, Historian, Stocl<ton resident for 40 years or longer.

o Devetopment Oversight Commission Do you work In Stockton or with a firm/organization that does business In Stockton? jjJ Yes 0 No State nameladdress offlrmlorganlzation:=== ______________________ ~ Are you any of the following (check any that apply) o Local archltecUdeslgner 0 Local Civil Engineer 0 Mixed Use Builder/Developer o Local Representative from public at-large 0 Local Non Profit Builder/Developer o Port of Stockton Exeoutlve (CEO or Designee) 0 San Joaquin Parlnershlp Exeoutive (CEO 0" Designee) Building Industry Association 0 Executive (CEO or Designee) Ql 0 Mixed Usa Builder/Developer Builder's Exchange 0 Executive (CEO or Designee) Ql 0 General Contraclor

C:IOoGum.nts and Settlngslbhunter.CITYOFSTOCKTONIMy DOGlimentsI125666-1.doo (Form adopted by City CounGIl on 10-10-95; Revised 12-13-10)


John McGaughey APPLICANT NAME

o Port Commission Do you reside within the Port District boundary or consistent with the City General Plan boundaries, plus a one·half mile strip on either side of the stockton Ship Channel from the Port to Disappointment Slough, If so for how long? ______ ~

o Public Art Advisory Committee (clrole any that apply) Employed as a professional visual artist, critic of contemporary visual art forums, or have knowledge of, or skill/experience In any of the following: activist for the visual environment, public art, regional/national Individual artists work, understanding of ethnlo/gender diversity, the Stockton Public Art Plan processes and Implications for the City, deolslon·maklng ability, willingness to tolerate/promote change, new artistic & design expressions, community activities slgnlfloant enough to confirm knowledge of Issues and Individuals within the community

o San Joaquin Regional Transit District Board Have you resided within the Transit District boundaries for at least one year? :¢ Yes 0 No Are you a resident In the City of Stockton? 9l)Yes 0 No

o Sports Commission (circle any that apply) If you are not a resident of Stookton, do you own and/or operate a business within the City or are a sponsol' or associated with a sports related event, name of business or event(s): ____________________ _

o Stockton Measure W Oversight Committee Do you reside within Stookton's geographic boundary? iii Yes 0 No Are you at least 28 years of age? 0 Yes 0 No Are you an employee of any vendor, contraotor or oonsultant doing business with the City of Stocl<ion? iii Yes 0 No

o Counoll Water Advisory Group Do you reside within one of the Stockton Municipal Utilities' three utility service areas? 0 Yes 0 No If so, state whloh one: _______________ ~

o youth Advisory Commlltee (fill In, circle, or check) High school enrolled In: Will you be e senior next committee term? DYes ONo Are you a member of one of the following Community Centers? MoKlnley, Seifert and Selrra Vista, Strlbley and Van Buskirk, other: -=--=CC"777-,----,-,---,--,~~_,_.~ Whloh Council District do you reside In? Dlslrlct 1, 2, 3, 4, 5, or 6 (leave blank If you do not know),


WORK EXPERIENCE: List nemes, addresses, and dates of employers for the last five (5) years. Attach additional sheets of paper If needed,

FROM: MO. 11 DAY 15 .YEAR 201 0 EMPLOYER NAME Ridge Communications, Inc,

TO: MO. DAY YEAR Present ADDRESS..::S:::=:a=-nC-'Rc.:=am~o,,-n,,-, ..::C"-A-'---__ c-: ___ _

DUTIES: Telecom site acquisition, development and real estate contract negotiation,

FROM: MO. DAY YEAR 1998 EMPLOYER NAME Sprint Corporation

TO: MO, DAY YEAR 2010 ADDRESS Pleasanton, CA & Overland Parl<, KS

DUTIES: Real estate contract negotiation, property management.

BUSINESS ENTERPRISES: List business name, Including fictitious name and address of any business enterprlseB currently or previously owned or operated,

FROM: MO. __ DAY __ YEAR __ BUSINESS NAME._N_I_A _____________ _

TO: MO,. __ ~DAY YEAR __ ADDRESS ___________ ~--------------

C:IDocuments and Settlngslbhunter.CITYOFSTOCKTONIMy DocumentsI126665·1.doo (Form adopted by City Council on 10·10·96; Revised 12. 13·10)

\


John McGaughey APPLICANT NAME

TYPE OF BUSINESS OR SERVICE RENDERED: _________________ _

A resume reflecting experience, oommunlty activities, or other qualifications not listed below may be attached In order to assist the Council In evaluating your application. (Optional)

EDUCATION: California Polytechnic State University, Pomona (BA in Urban and Regional Planning)

CONFLICT OF INTEREST: State and local law requires that you abstain from partlolpatlon In decisions that may affect your financial Interests, Including sources of Income and Interest In real property or Investments. In addition, If appointed you may be required to fill out a disclosure statement that Identifies certain of your financial Interests beginning with the Immediate Iwelvemonth period prior to your appointment. Based on your best judgment, does this board or commlsston make decisions that may affect any sources of Income, Interests In real property, or Inveslments of you or your spouse?

Ves __ No _X __ If yes, please explain. Identify any organlzallons, assoolatlons, corporallons, or entities by which you are employed or associated Ihal might be affected by decisions of this board or commission and the positions you hold .. ________________________________ _


In acoordance with Government Code Sections 87300 - 87313 and the City of Stockton's Conflict of Interest Code, this Board/Commission/Committee may be designated to file Statements of Economic Interests.

If you are appOinted to this Board/Commission/Committee, you may be required to file statements disclosing certain types of Information so that the public can be made aware of potential conflicts of interest. The types of disclosure are:

Investments Interests In Real Property (other than your residence) Interests In Real Property Held by a Business Entity or Trust Investments Held by a Business Entity or Trust Income (other than loans and gifts) Income - Travel Payments, Advances, Reimbursements Income Gifts Business Positions Commission Income Received by Brokers, Agents, and Salespersons Income and Loans to a Business Entity or Trust Income from Rental Property

If you have any questions regarding disclosure reqUirements, please contact the City Clerk's Office at 937·8458.

CONVICTIONS: Convlotlon of a orlme Is not neoessarlly a bar to appointment. Eaoh case Is considered separately based on requirements of Ihe position; however, failure to list convlollons may result In dlsquallfloatlon.

1. Have you ever been convloted of a felony? If yes, please explain:

No

2. List eaoh civil action, If any, In which punitive or exemplary damages have been assessed against you, Indloatlng In eaoh Instance Ihe date of Iha trial, court judgment and Ihe loc8tlon of Ihe court whloh rendered Ihe judgment:

N/A C:IDocuments and Seitingslbhuni.r.CITYOFSTOCKTONIMy DoollmenisI126666·1.doc (Form adopted by Clly Council 01110-10-96; Revised 12-13-10)

" , , City of stockton APPLICATION CONTINUED Page 5 of 5

John McGaughey

APPLICANT NAME

I DECLARE, UNDER PENALTY OF DISQUALIFICATION AND TERMINATION, THAT ALL STATEMENJ;S-I TH APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWL OOE.

Signature -=i~~ -J'{2~= ~~-~ -2-r-_-_-_________ Date ---"gJ"'t1-~-",'t-')-I;;-~/-.z---~ Please Iden Ily ny specialized aooommodations needed for equal partlolpatlon: _____________ _

The following Information Is voluntary and Is gathered In aooordanoe with state and Federal laws for the purpose of evaluating the effeotlveness of our Affirmative Aotlon and reorultment efforts. Please oheok: __ Male Female

_White (Not Hispanic Origin) All persons having origins In any of the original peoples of Europe, North Afrloa or the Middle East

_Blaol< (Not Hlspanlo origin) All persons having origins In any of the Blaok raolal groups of Afrloa.

_Hlspanlo All persons of Mexloan, Puerto Rloan, Cuban, Central or South Amerloan or other spanish oulture or ol'lgln, regardless of raoe.

_Amerloan Indian or Alaska Native All persons having origins In any of the original peoples of North Amerloa and who maintain oulturalldentlfloations through tribal affiliation or oommunlty reoognltlon. Please Identify your tribal aflillation.

_FIlipino All persons having origins In the Philippine Islands.

_Asian

The Stockton City Council appoints members to the various City of Stookton Boards and Commissions. The Counoll also appoints representatives to serve on various other San Joaquin County agencies as well. Please check the boxes below If you are interested in serving on any other boards/oommisslons. To find out about what these boards/commissions do and If you qualify, please visit the City of Stockton website at www.stooktongov.com/commisslons

!jI49·99 Cooperative Library System Advisory Board

!jIArts Commission

!jIBulldlng and Housing Board of Appeals

!jICentral Parking District Advisory Board

!jIClty Counoll Salary Setting Commission

!jIClvll Servloe and Equal Employment Commissions

!jICllmate Aotlon Plan Advisory Committee

!jIcommunlty Development Committee

!jIcultural Heritage Board

!jIOevelopment Oversight Commission

!jIHandlcapped Aocess Board of Appeals

[jiMeasure W Oversight Committee

!jIParl<s and Reoreatlon Commission

!jI Planning Commission

!jI Port Commission

!jI Publlo Art Advisory Committee

!jI Redevelopment Commlsslon/Relooatlon Appeals Board

!jI San Joaquin County Commission on Aging

!jI San Joaquin County Mosquito And Veotor Control District

!jISan Joaquin Regional Transit Dlstrlot Board

!jISports Commission

!jI Water Advisory Group

~ Youth Advisory Commission (must be In high school to serve on this Commission)

C:IOoGuments and Setllngslbhunter.CITYOFSTOCI<TONIMy DOGumenlsl125666·1.doG (Form adopted by CilyCounGIl on 10·10·96; Rovlsed 12-13·10)

CITY OF STOCKTON

illt; ~ ;}:~I~ I~ CIlY CLERK

APPLICATION FOR APPOINTM NT ClrY OC srO_CK_TON_--,

AND BACKGROUND INFORMATION FOR . BOARDS, COMMISSIONS, AND COMMITTEES

1) Please provide all Information requested. 2) Please print or type all entries In black or blue Ink only. 3) Any allachments must be single sided, 811, X 11 paper. 4) Information contained on this form Is public record. 5) With the exception of the Information contained on this firsl page, all other Information contained In this application may be

posted on the City's website for public view. 6) Submit completed application to: Office of the Clly Clerk, City Hall 1st Floor, 425 North EI Dorado Street, Stockton, CA

95202; Phone: (209) 937-8459

I

Stockton b:ft:d AII'A/l'rIl!lIltCl

\ lill. 2004 1999

BOARD/COMMISSION/COMMITTEE NAME:~lj·11't ~~Y'Lc-Lll£l'VI'!1llWlI1:·!l()Ylan;h~-A-)£,j~, 7p~rJ't-Complete Supplemenlal Questionnaire, If ap IIcable I

S~~~ CA Mi?~~X\ Applicant Name: F'I ~Gh Home Address: IJ08st fllcwcl...... St-

Street Mdress City State Zip· Mailing Address Of different Ihan home address) _______________________ _

Preferred Contact Phone (200) (g'zq '21'21(,:, Alternate Phone (2((1) 4/& 7 01 (~1...

Business Phone ( Fax (

L/ ~rl (length ftime)

I declare under penalty of disqualification/termination thai I have been a resident at the above address for

Resident of City Council Dislrict No.: ~ Are you an Incumbent? Yes __ No /'

The City of Stockton uses email as the preferred melhod of communication regarding your application. Is this acceptable to you? Yes ~ No __ . If you have checked "No", please Ident'lfy how you prefer to be contacted: ________ _

Email Address: oh-Z4-eClof-k~ % €/@M ~I 'l ,CoW)

Employer Name Oh.. - '~-,p ;;;,ct t>th,~'~W' _ J ..., , (11. / /. /)A ,aJ?of'!..'rll'" .• Employer Address '/{/,- ~.-VC- e JI{7Jc.tLrc'/Y'l C;.'lj .L_hbVL.,

Voter Registration: The City of Stockton requires members of the City Council Salary Seiling Commission, Civil Service Commission/Equal Employment Commission, and San Joaquin County Mosquito and Vector Control District to be registered voters of the City of Stockton. Please fill out the Information below If you are applying for one of these positions so that your voter registration may be verified: /1___ A __ 'A /IJ{U", /2!!~,.q

L_ 1.l-I.2.-/.:L "'T,.<!.. -tlfao/<eCl< ;n~ V,-" Name: GtX"~00-V-4 f\ 15~ Address: 11 0 Ll H 0., ~tt.e ,Sq.-"." s:r* "'~"" 'J52Q" Slgn~u~: -

(Form adopted by City Council on 10-10-95; Revised 12113(10) ::ODMA\GRPWISE\COS.CC.CC_Llbrary: 125665.1


G~~Pth~ , PPLI ANT NAME

Pleas

Have you served on an advisory group before? _'_' _ If yes, please explain: ________________ _

How did you hear about the position? 56/') me l~t(f- &{d fVl..e a..,baut- ;'t, City Council Policy 100-2 states that board/commission members are required to attend meetings on a regular basis, If appointes!> will you be able to attend meetings regularly and devote the time necessary to fulfill your duties as a member? Yes V No __

Do you or Immediate family members have any relatlonyhlp (professional, financial, other) that may present a potential conflict of Interest for this advisory group? Yes __ ,No _v__ . " ", ff yes, please explain _._. _' ________________________________ _


o 49-99 Cooperative Library System Advisory Board You must be a resident of San Joaquin County, but not the City of Lod!. Do you meet this requirement? 0 Yes 0 No

o Stockton Arts Commission Outside of your profession Indicate what type of Arts you are active in (circle any that apply): Music, Dance. Theater, Cinema, Photography, Architecture, Art Criticism, Textile Arts, Literary Arts, the Visual Arts, Including (but not limited to) the Public or Environmental Arts, Graphic Arls, Design, Drawing, Painting, Printmaking, Sculpture, Ceramics, and Art History Are you Interested In or accomplished In fund-raising? 0 Yes 0 No

o Building and Housing Board of Appeals/ Handicapped Access Board of Appeals Do you have experience In any of the following areas (circle any that apply): General Building Contractor, Plumbing Contractor, Electrical Contractor, or Mechanical Contractor; Engineer or Architect. Are you a disabled citizen? 0 Yes 0 No

o Centrat Parking District Advisory Board Do you own real property or are you an execulive officer of a corporation that owns real property within the Central Parking District? 0 Yes 0 No Specify property address(es): ___________________ _

o Climate Action Plan Advisory Committee Do you actively represent any of the following Interest groups within the City of Stockton (circle any that apply): Environmental, Non-Profit Community Organization, Labor, Business, Developer

o Cultural Heritage Board Are you knowtedgeable have experience In, or extensive background In any of the following areas (circle any that apply): Historic or cultural traditions of the community, preservation, architecture, construction technology, real-estate, construction Industry, California licensed Architect, Historian, Stockton resident for 40 years or longer,

o Development Oversight Commission Do you work In Stockton or with a firm/organization that does business In Stockton? 0 Yes 0 No State name/address of firm/organization: Are you any of the following (check any th::a"t -:::a=pp::ily::»-----------------------o Local archltecVdeslgner 0 Local Civil Engineer 0 Mixed Use Builder/Developer o Local Representative from public at-large 0 Local Non Profit Builder/Develop'er o Port of Stockton Executive (CEO or Designee) 0 San Joaquin Partnership Executive (CEO or Designee) Building Industry Association 0 Execullve (CEO or Designee) Ql 0 Mixed Use Builder/Developer Builder's Exchange 0 Executive (CEO or Designee) Ql 0 General Contractor

::ODMAIGRPWISEICOS.CC.CC _Library: 125665.1 (Form adopled by Clly Council on 10·10·95: Revised 12-13-10)


P!PPLICANT NAME

o Port Commission Do you reside within the Port District boundary or consistent with the City General Plan boundaries, .ptus a one-half mile strip on eliher stde of the Stockton Ship Channel from the Port to Disappointment Slough, if so for how long? ______ _

o Public Art Advisory Committee (circle any that apply) Employed as a professional visual arlist, critic of contemporary visual art forums, or have knowledge of, or skill/experience In any of the following: acllvlst for the visual environment, public art, reglonal/nallonallndlvldual arllsts work, understanding of ethnic/gender diversity, the Stockton Public Art Plan processes and Implications for the City, declslon-mak'lng ability, willingness to totBrate/promote change, new artlsllc & design expressions, community acllvilies significant enough to confirm knowledge of Issues and Individuals within the community

, San Joaquin Regional Transit District Board J Have you resided within the Transit District bojindarles for at least one year? ~ Yes 0 No Are you a resident In the City of Stockton? l'ZI Yes 0 No

E!6 Sports Commission (circle any that apply) . _ .. __ .. If you-are not areslderiiofStockton, do you own and)or operate a business within the City or are a sponsor or associated with a sports related event, name of business or event(s): ____________________ _

o Stockton Measure W Oversight Committee Do you reside within Stockton's geographic boundary? 0 Yes 0 No Are you at least 28 years of age? 0 Yes 0 No Are you an employee of any vendor, contractor or consultant doing business with the City of Stockton? 0 YBS 0 No

J Council Water Advisory Group Do you reside I)'lthln one of the Stockton Municipal Utilities' threB utility service areas? ~ Yes 0 No If so, state which one: {J I srnc.t (0

o Youth Advisory Committee (fill In, circle, or cheCk) High school enrolled In: Will you be a senior next committea term? DYes ONo Are you a member of one of the following Community Centers? McKinley, Seifert and Seirra Vista, Stribley and Van Buskirk, other: -;;---;;c=;--;-c--;--,--___ --,-;-;--;;-==.,--;;--, Which Council District do you reside In? District 1, 2, 3, 4, 5, or 6 (leave blank If you do not know).


WORK EXPERIENCE: List names, addresses, and dates of employers for the last five (5) years. Attach additional sheets of paper If needed.

FROM: Mo . .ML_DAY '5 YEAR '2aJ{~ EMPLOYER NAME Rt:'1W ConsYrvcf-.io r, TO:.. Mo.C)L1 .. DAY f£ YEAR200 j ADDRESS 550 bJ. t4C!U:.nvllk Q.,J •

. ' Dll'fIES: .:sU""IOI'" ..::shl'Vl-xtc.v- j_ ~.pf!- ~1YLeJ:uQ.. .-, : .

FROM: MO. 0 5 DAY \ () YEAR 20cPl EMPLOYER NAME:-:-""'--:'---"--""'='iF'-~~"":"---':'4--_ TO: MO. Y'~$<-DAl.f- YEAR ADDRESSc'-f....:~~· L-'l":t-..=~-¥...£.l!L:..=-o_~~ o UTI ES: ~~ e~, ~---'(}"'" Vl,--,-"-o\,--,,,('jJ,--,<p-_~ ..Jl,.""J."--,',,,-,' hJ,--"('fL!!--'---~~""'-.l--..-'-1l!Jl.!."..J'.>,,Lf BUSINESS ENTERPRISES: List business name, Including fictitious name and address of any business enterprises currently or previously owned or operated.

FROM: MO.OL/ DAY () I YEAR 200QBUSINESSNAME Oll:ke ~I-A/n~G( TO: MO. 07 DAY ')6 YEAR 'loU" ADDRESS .1/1 tv,· D,,6 J;cm (.ll. S/ j~k.~ 17 0f

::ODMAIGRPWISEICOS.CC.CC_Llbrary:125665.1 (Form adopted by City Council on 10-10-95: Revised 12-13-10)

, ,


TYPE OF BUSINESS OR SERVICE RENDERED:

APPLICANT NAME

A resume reflecting experience, community activities, or other qualifications not listed below may be attached in order to assist the Council in evaluating your application, (Optional)

EDUCATION: i3&rnf e Awa.if.i' ~e..e f)2.0,/'/7 (Jot") , CI®jC! ! Sac~?f<1.f'.fJ) <'1.';'.'

CONFLICT OF INTEREST: State and local law requires that you abstain from participation in decisions that may affect your financial Interests, Including sources of Income and Interest In real property or investments. In addition, If appointed you may be required to fill out a dlsolosure statement that Identifies certain of your financial Interests beginning with the immediate twelve· month period prior to your appointment. Based on your best Judgment, does this board or commission make decisions that may affeot any sources of Income, Interests in real property, or investments of you or your spouse?

Yes __ No 'v If yes, please'explaln. Identify any oiganlzations, associations, oorporations, or entiii~~ bywh'loh you are employed or associated that might be affected by decisions of this board or commission and the positions you hold. __________________________________ _




Investments Interests in Real Property (other than your residence) Interests in Real Property Held bya Business Entity or Trust Investments Held by a Business Entity or Trust Income (other than loans and gifts) Income - Travel Payments, Advances, Reimbursements Income Gifts Business Positions Commission Income Received by Brokers, Agents, and Salespersons Income and Loans to a Business Entity or Trust Income from Rental Property

If you have any questions regarding disclosure requirements, please contact the City Clerk's Office at 937·8458,

CONVICTIONS: Conviction of a crime Is not necessarily a bar to appointment. Each case Is considered separately based on requirements of the position; however, failure to list convictions may result In disqualification.

1. Have you over been convioted of a felony? If yes, please explain:

I~ ur 111) 2CJOI~ 2. List eaoh civil action, if any, In which punitive or exemplary damages have been assessed against you, Indicating In each

Instance the date of the trial, court judgment and the location of the court which rendered the Judgment:

::ODMAIGRPWISEICOS.CC,CC_Llbrary:125665,1 (Form adopted by City Council on 10·10·95; Revised 12·13·10)

City of Stockton APPLICATION CONTINUED Page 5 of 5 .

I DECLARE, UNDER PENALTY OF DISQUALIFICATION AND TERMINATION, THAT ALL STATEMENTS IN THIS APPLICAT ON ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDG /

Signature Date 07 j;; 3/20/2 ~ I

Please Identify any specialized accommodations needed for equal participation: ______________ _

The following Information Is voluntary and Is gathered In accordance with State and Federal laws for the purpose of evaluating the effectiveness of our Affirmative Action and recruitment efforts. Please check: __ Male Female

V"White (Not Hispanic Origin) All persons having origins In any of the original peoples of Europe, North Africa orthe Middle East

_Black (Not Hispanic Origin) All persons having origins In any of the Black racial groups of Africa.


_American Indian or Alaska Native All persons having origins In any of the original peoples of North America and who maintain cultural Identifications through tribal affiliation or community recognition. Please Identify your tribal affiliation.


_Asian

The Stockton City Council appoints members to the various City of Stockton Boards and Commissions. The Council also appoints representatives to selVe on various other San Joaquin County agencies as well. Please check the boxes below if you are interested in serving on any other boards/commissions. To find out about what these boards/commissions do and if you qualify, please visit the City of Stockton website at www.stocktongov.com/commissions

~9-99 Cooperative Library System AdVisory Board

!"!Arts Commission

~ilding and Housing Board of Appeals

!"fCentral Parking District Advisory Board

g6ty Council Salary Setting Commission

~Ivll Service and Equal Employment Commissions


!lIf6ommunlty Development Committee

OCultural Heritage Board

IltDevelopment Oversight Commission

OHandlcapped Access Board of Appeals

OMeasure W Oversight Committee

~~arks and Recreation Commiss1on

::ODMA\GRPWISE\COS.CC.CC _ Llbrary:125665.1

~Iannlng Commission

~ort Commission

G,}1"ubllc Art Advisory Committee

E!(Redevelopment Commission/Relocation Appeals Board



1"l13an Joaquin Regional Transit District Board

~ports Commission

l\!I'Water Advisory Group

o Youth Advisory Commission (must be In high school to serve on this Commission)

(Form adopted by City Council on 10-10-95; Revised 12·13·10)

flPR 1 0 2013 ~\CITYOf ~'

Stockton

STOCKTON OITV OLERK CIT\' OF STOCKTON

" APPLICATION FOR APPOINTMENT AND BACKGROUND INFORMATION FOR

BOARDS, COMMISSIONS, AND COMMITTEES 1) Please provide all information requested. 2) Please print or type all entries in black or blue Ink only. 3) Any attachments must be single sided, 8 Y. X 11 paper. 4) Information contained on this form is public record. 5) With the exception of the information contained on this first page, all other information contained in this application may be

posted on the City's website for public view. 6) Submit compieted application to: Office of the City Clerk, City Hall 1st Floor, 425 North EI Dorado Street, stockton, CA

95202; Phone: (209) 937-6459

2004 1999

BOARD/COMMISSION/COMMITTEE NAME:4ttt4.c~@:-~~~~~2J~th-LCd.'.t&r~ yr V~) Com lete Supplemental Questionnaire, If applicable

Applicant Name: ,So! x:ed.c k Last \

Home Address: 11'11.1 t'l DCII 1£\ Q [;, Sireet Address ..:;

Rd mDnioJ 1 e I Chr i sb r\<k

±J!\th~ Celddle qSctoJ §tty state Zip

Mailing Address (if different than home address) ______________________ _

Preferred Contact Phone DiY" ) lot Q~l - 5 ';:;)55 Alternate Phon~D" ) LO 3· 0'0 W] Business Phone ( Fax (

I declare und ~peA81ty1lf1llsquallilc'9ti<lftlte Inatlon that I have been a resident at the above address for \ Uf, 3 [flo 1\1\\ s. V' (Iiai!gth o?time)

sident of Cit Council District No.: ~ Are you an incumbent? Ves __ No ~ 5T ccurd'u })ISiJ It.~ ~ ;:)

The City of Stockton"uses email as tna pre'mrr ethod of communication regarding your application. Is this acceptable to you? so-X-- NO __ . If au ~ ed"No", please identify how you prefer to be contacted: _______ _

Email Address: COO!:?,qc\ QOS;)C0 CCffl)(O:-.t, net Employer Narne \.e("')l"iY\ Ce n-\rcerl ScrVt(f'S EmployerAddress ,Qyo 1'0, Unum ht StocLj'OD Cll ClSQa") - )

Voter Registration: The City of Stockton requires members of the City Council Salary Seltlng Commission, Civil Service Commission/Equat Employment Commission, and San Joaquin County Mosquito and Vector Control District to be registered vot~rs a! the City of Stockton. Please fill out the information below If you are applying for one of these pOSitions so that your voler L 1.1 n

reglstrehonmaybe~erified: (" ir",;{s::.13 IMIIlIh1/h~~ -t5U?>/~ Name: ct\o'(\H{)Ue, 0(\'\'l(J'(1<~ , tPJ t!t'k;-Address: leQ'6 'Uo\.l91.C\S lld City: (' Zip Code: 'lSi/!oJ

Signature: ~'c-,-:;I-"-it-:::.,.r1~====------

(Form adopted by City Council on 10,10-95: Revised 12/13/10) C;\Oocument, and Selllng,lbhunter.CITYOFSTOCKTON\My Dooumenls\125665-1.doc



How did yOU hear about the position? ...... S..Ldi-"'<X""""'k.f:L(Ul)(\-"S+)LI~~, ...... C ..... :t\l..ltf'o-w-_'U'v\>J.:f.;...lb>-Ls ... twILC-G'=' '--___ _

City Council Policy 100-2 st~tes that board/commission members are required to attend meetings on a regutar baSiS, If apPoin)(- Will you be able to attend meetings regularly and devote the time necessary to fulfill your duties as a member? Ves No __ _

Do you or immediate family members have any relatip~hlp (professionai, finanCial, other) that may present a potential conmct of Interest for this advlsury glOup? Ves __ No ~ If yes, please explain ______ . ____________________________ _

SUPPLEMENTAL QUESTIONNAIRE; Please complete the following if applying for a vacancy on any of these listed boards/commissions/committees:

o 49-99 Cooperative Library System Advisory Board Vou must be a resident of San Joaquin County, bul not the City of Lodi. Do you meet this re~ulrement? 0 Ves 0 No

o Stockton Arts Commission Outside of your profession indicate what type of Arts you are active in (circle Bny that apply): Music, Dance. Theater, Cinema, Photography, Architecture, Art Criticism, Textile Arts, literary Arts, the Visual Arts, including (but not limited to) the Public or Environmental Arts, Graphlo Arts, Design, Drawing, Painting, Printmaking, SCUlpture, Ceramics, and Art History Are you Interested in or accomplished in fund-raising? 0 Yes 0 No

o Building and Housing Board of Appeals/ Handicapped Access Board of Appeals Do you haVe experience in any of the following areas (circle any that apply): General Building Contractor, Plumbing Contractor, Electrical Contractor, or Mechanical Contractor: Engineer or Architect, Are you a disabled citi.en? 0 Yes 0 No

o Central Parking District Advisory Board Do you own real property or are you an executive officer of a corporation that owns real property within the Cent",,1 Parking District? 0 Ves 0 No Specify plUpalty address(ss): __________________ _

o Climate Action Plan Advisory Committee Do you activelY represent any of the following interest groups Within the City of Stockton (circle any that apply); EnVironmental, Non-Profit Community Organization, Labor, Business, Developer

o Cultural Heritage Board Are you knoWledgeable have experience in, or extensive background in any of the following areas (circle any that apply): Historic or cultural traditions of the community, preservation, architecture, construction technology, real-estate, conslrucllon Industry, California licensed Archltec\, Historian, Stocllton resident for 40 years or longer.

o Development Oversight Commission 00 you Work in Stockton or with a firm/organization that does business in stocllton? 0 Ves 0 No State name/address offirm/organization:=== ______________________ _ Are you any of the following (check any that apply) o Local architecUdesigner 0 Local Civil Engineer 0 Mixed Use Builder/Developer o Local Representative from public at-large 0 Local Non Profit BuilderlDeveloper o Port of Stockton Execullve (CEO or DeSignee) 0 San Joaquin Partnership Executive (CE:O or Designee) Building Industry Association 0 executive (CEO or Designee) ill 0 Mixed Use t!ullder/Developer Builder'S Exchange 0 Executive (CEO or Designee) ill 0 General Contractor

C:\Documenls and Seltlngs\bhuntef.CITYOFSTOCKTONIMy Documents\126665-1,doc (Form adopted by City Council on 10-10-95: Revised 12-13,10)


o Port ComnUsslon

NJOf\r\qjA f.t SCI \)(trlCA) PPLICANT NAME

Do You reside within the Port Distriot boundary or consistent with the City General Plan boundaries, plus a one-half mile strip on either side of the stockton Ship Channel from the Port to Disappointment Slough, if so for hoW long? ______ _

o Public Art Advisory Committee (cirole any that apply) Employed as a professional visual artist, critic of contemporary visual art forums, or have knoWledge of, or skill/experience In any of the following: acUvlst for the visual environment, public art, reglonallnational individual artists work, understanding of ethnlofgender diversity, the Stockton Public Art Plan protesses and implications for the City, decision-making ability, willingness to tolerate/promote chahge, new artistic & design expressions, community activities significant enough to confirm knowledge of issues and Individuals within the community. Mu~\ be a resident of Stockton for at I .. ~t 3 yeats.

o San Joaquh' ReQlonal Transit District Board Have you resided within the Transit District boundaries for al least one year? 0 Yes 0 No Are you a residenl in the Cily of Stockton? 0 Yes 0 No

o Sports Commission (circle any that apply) If YOU are not a resident of Siockton, do you own and/or operate a business within the Cily or are a sponsor or associated with a sports related evenl, name of business or event{s): ___________________ _

o Stockton Measur. W Oversight Committee Do you reside Wlthln Stockton's geographic boundary? 0 Yes 0 No Are YOll at least 28 years of age? 0 Yes 0 No Are you an employee of any vendor, contractor or consultant doing business with Ihe City of Stockton? 0 Yes 0 No

o Council Water Advisory Group Do yOU reside within one of the Stockton MuniCipal Utilities' three utility service areas? 0 Yes 0 No If so, state which one: _______________ _

[j Youth Advlsol')' Committee (flll iii, circle, or oheck) High school enrolled In: Will you be a senior next committee term? DYes DNa Are you a member of one of the following Community Centers? McKinley, Seifert and Seirra Vista, Stribley and Van Buskirk, other: Whlch""'Co--o-un-c""II-=D""is""tr""ic:-t d""o-'-y""0-"u-re-s7"ld;-e7in"'?:-D"'iC"st"'ri""'ct-;1---:, 2, 3, 4, 5, or 6 (leave blank if you do not know).


WORK EXPERIENCE: Lisl names, addresses, and dates of employers for the lasl five (5) years. Atlach additional sheets of paper if needed,

FROM: MO.s?~t DAY--"N,,-l,--_YEAR OlOol EMPLOYER NAME Pef::':O!\ Cenirr",d ScrV I(-e~ TO: MO. Pf-ec,q DAY ___ YEAR. __ ~ADDRESS r2t.to 10. \)'1\\00 S'>tj Stock:hY) qSaoS DUTIES: £coIOjlca\ SU prod 1'D gr\IJITh lA)t-\b dloo.hlh<\P:::, (See Ctlta<\xd n~ull¥!)

FROM: MO.JU De ' DAY_~ __

TO: MoJunt< DAY __ -,-_

DUTIES: -{!:fOd\..I(];:~---'::JUIlt1'ruLCllJJ.l'j~-::tb-.ID:illIrru~<-llIT~Thl.:O~~o.-!

BUSINESS ENTERPRISES: list business name, including fictitious name and addf]lss of any business enterprises currently or previously owned or operated.

FROM: MO. __ DAY ___ YEAR BUSINESS NAME _______________ _

TO: MO. DAY YEAR __ ADDRESS _________________ _

C:IDocumenls and Setllngslbhunler.CITYOFSTOCKTONlMy DocumentsI125665-1.doc (Form adopled by City Council on 10-10-95; Revised 12-13-10)


TYPE OF BUSINESS OR SERVICE RENDERED: ________________ _

A resume reffecting experience, community activities, or other QUalifications not listed below may be attached In order to assist the Council in evaluating your application. (Optional)

EDUCATION:£¥rtRG.=~AnC1f( ~h)r~~~)WDf~ ff'a\Of

CONFLICT OF INTEREST: state and 1008118w requires that you abstain from participation in decisions that may affect your financial interests, Including sources of income and interest in real property or InVestments. In addition, if appointed you may be required to fill out a disclosure statement that Identifies certain of your financial interests beginning with the immediate twelvemonth period prior to your appointment. Based on )'our best judgment, does this board or commission make decisions that may affect any sources of income, Interests in real property, or investments of you or your spouse?

Yes __ No X- If yes, please explain. Identify any organizations, associations, corporations, or entitles by which you are employed or associated that might be affected by decisions of this board or commission and the positions you hold. ________________________________ _


In accordance with Government Code Sections a7300 - 87313 and the City of Stockton's Conflict of Interest COde, this Board/Commission/Committee may be designated to file Statements of Economic Interests_

If you are appolntecl to this Board/Commission/Committee, you may be required to file statements disclosing certain types of information so that the public can be made aware of potential conflicts of Interest. The types of disclosure are:

InveStments Interests In Reai Property (other than your residence) Interests in Real Property Held by a Bllsinoss Entity or 'rrust Investments Held by a Business Entity or Trust Income (other than loans and gifts) Income _ Travel Payments, Advances, Reimbursements Inconie Gifts Business Positions Commission Income Received by Brokers, Agents, and Salespersons Income and Loans to a Business Enlity or Trust Income from Rental Properly

If you have any questions regarding disclosure requirements, please contact the City Clerk's Office at 937-8458_

CONVICTIONS: Conviction of a crime is not necessarily a bar to aPPOintment. Each case is considered separately based an requirements of the position; however, failure to tist convictions may result in disqualification.


ND 2. List each civil action, if any, in which punitive or exemplary damages have been assessed against you, Indicating in each

instance the date oftha trIal, court jUdgment and the IQcation of the CQurt which rendered the judgment:

C:IOocuments and Settlng;\t)hunter.CITYOFSTOCKTONIMy DocumentsI125665-1.doc (Form aoopte(ll>y City Council on 10-10-95: Revised 12-13_10)

City of Stockton APPLICATION CONTINUED Page 50f5

\I'D{)I~A~ Sa \ Aceelu I

PLiCANT NAME

I DECLARE, UNDER PENALTY OF DISQUALIFICATION AND TERMINATION, THAT ALL STATEMENTS IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWL GE.

Signature -\,------,.''-'"'+-'If--\-------

commodations needed for equat participation: -'-'tVILJ/-/LAL--__________ _

The following Information is voluntary and is gathered In accordance with State and Federal laws X the purpose of evaluating the effectiveness of our Affirmative Action and recruitment efforts. Please check: __ Male Female

_White (Not Hlspanio Origin) Ail persons having origins in any of the original peoples of Europe. North Africa or the Middle East

_Black (Not Hispanic Origin) Ail persons having origins in any of the Black racial groups of Africa,

)LHispanlc All persons of Mexican, Puerto Rican, Cuban, Central or South American or other lipan Ish oulture or origin, regardless of race .

. -American Indian (lr Alaska Native All persons having origins In any of the original peoples of North Amerlea and who maintain cultural identifications through tribal affiliation Or community recognition. Please identify your tribal affiliation.

_Pllipino All persons having origins in the Philippine Islands,

_Asian

The Stockton City Council appoints members to the various City of stockton Boards and Commissions, The Council also appoints representatives to serve on various other San JoaqUin County agencies as well. Please check the boxes below if you are Interested in serving on any other boards/commissions, To find out about what these boards/commissions do and if you qualify, please visit the City of Stockton website at www.stocktongov.com/commissions


DArts Commission

OBuliding and Housing Board of Appeals

OCentral Parking District Advisory Board

P\fClty Council Salary lietting Commission

OCivii Service and Equal Employment Commissions


~Community Development Committee

OCultural Herlta.ge Board


OHandlcapped Acces$ Board of Appeals

OMeasure W Oversight Commillee

Plta~s and Recreation Commlsslon


o Port Commission

o PubliC Art Advisory Committee



o lian Joaquin County Mosquito And Vector Control District

,$san Joaquin Regional Transit District Board

OSports Commission

;;trwater AdvisorY Group

o Yo~th AdVisory Commission (must be In high school to serve on this Commission)

C:IDocumenls and Sellingslbhunler.CITYOFSTOCKTONIMy DocumentsI125665-1.doo (Form adopted by Clly Council on 10-10·95; Revised 12· 13-10)

Monique Sauceda

I am currently a Social Work major student at CSU, Sacramento with an

anticipated graduation of Spring 2014. I possess an Associate of Arts in Elementary

Education Teacher Preparation from San Joaquin Delta College. I am employed full

time as an Administrative Assistance at Person Centered Services, Supported Living

Services. We provide support to adults with varying disabilities (physical, emotional,

and/or mental) to reside in their own homes/apartments. I volunteer twice monthly at

Bear Creek Community Church as a mentor with children aged 2-4 years of age. I am

an active parent participant in both the Save Science Camp committee for Lincoln

Unified School district and my daughters' local swim team, the Village Oaks Stingers,

coordinating various fundtaisers and collecting donations.

I have resided in Stockton for the past six years with my husband and two

daughters, aged three and ten. I was born and raised in Modesto, CA up until my move

to Stockton; stemming from my husband's job (at the time) promotion. I enjoyed the

change in scenery and my time here in Stockton thus far.

Although I have not previously served on a board or commission, I find my Job

experience, education, and volunteer experiences have provided me with a strong

foundation to pursue this endeavor.

Monique Sauceda

1848 Douglas Rd, Stockton, CA 95207 (209) 662-8258 [email protected]

Objective

Education

Human Service Experience

Other Vocational Expetience

Volunteer \'\fork

To procure a position 011 " lllJlInl/ commission Wlthit1 the city of Stockton/Slill Joaquin County to be an activclyiuvolved citizen and promote sodal justice.

Bachelor of Social Work (Spring 2014) CSU SaC,.iIllJClJto, Sacramento, California

AI/,J!f/sI2011 .Pre,relll

Associate of Arts, Elcmelitary Education Teacher Preparation with Honors

r"Hllmy 2006·D,mJJ/Jc,. 20 1 0

St/II jor/qllill Della College, Modesto, California

Petsoll Celltel'cd Services, Stockton California September 2006·Pmelfl

Admi,ustrau"e Assistant Ecological suppott to adults with disabilities to live successfully in their own homes by:

• Problem solving, decision making, life coaching • Intell'ersonru rclationship skills development • Attend $cheduled medical/clent"l appointments

Bi.monthly On·call staff to assist with emergency/crisis response Assume rCCCi)tiollist duties Assist staff with .t~ninL,tralive dnties as requested Complete necessary monthly constimet Quarterly reports

MedAmetica Billing Services, Il\C., Modesto, California

Mcdi,al Biller

jllll' 2005JI/i/Q 2006

Using coded data to produce nild submit claims to Insurance compHnies Warking directl), with the insurance company and patient to get" claim processed and 1>aid VCJ.'ifying patients' insurance CQvcroge

McDonald's, Modesto, California

Assistant Manager Responsible far hiring and training of new employees Oversee restalltant operations such as food safety and quality

F,bl7lary 2003-Ap,;/2005

Ensuring custome).' satisfaction and resolving customer compl:ilnls expeditiously and appropriately

Bear Creek Comnlunity Church, Lad!, CA

Bear Cubs lIfeJltOJ (2-3 ytlilr olds) Age appropriate weekly lessons

.. Encourage bask Cluistian mannerisms Promote positive reflection of self Age.Je"cl explanation of Bible history and 'tories

AP/iI20/t·Pmelll

CITY OF STOCKTON

APPLICA nON FOR APPOINn~Ef\nL~~~~~~1 AND BACKGROUND INFORMATION FOR


1) Please provide all InfonnaUon requested. 2) Please print or type all entries in black or blue ink only. 3) Any attachments must be single sided, 8 11, X 11 paper. 4) Inlonnation contained on this form is public record. 5) With the exception of the Infonnation contained on this first page, all other infonnaUon contained in this application may be

posted on the City's website for public view. 6) Submit completed application to: Office of the City Clerk, City Hall 1st Floor, 425 North Et Dorado Street ,~kton, CA 1

95202; Phone: (209) 937-8459 ;q, . f.p e.."" BOARD/COMMISSION/COMMITTEE NAME: cc:.e , If; OtJ\.."J /

Complete upplement Questionnaire, if applicable

Applicant Name: __ S-";=,b,,,,-,U<.....L\ ."e.=-___ l.::..::.....::.V....;C-=.;I.:,;.h..:;· '-'o\...J<..;g"""-_--OCC"T.;"_:R---'-\~ ____ _ 0. I. ~>lst7 M '0 Ficst - ...... Mlddl~ J-"'" ,.- "IL n 19

Home Address: l)!,1!ll GI. f"11\'I!...." ~ t \=f'iJ '::::i):" cJS,. \ bl/\ yr -I 5.;1. Street Address II City State Zip

Mailing Address (If different than home address) ______________________ -:

Preferred Contact phone ('3-0t() q](1a t.t '8"' 0 A Alternate Phone (al>fl_t.t-"-7...L-3,,,· ,--_'-l,,--,,~,-,O::::...l ~x( ) ___________________ ~-

;l.l~ Business Phone ( )---------

(length of tI~e) I declare under penalty of disqualificationltennination that I have been a resident at the above address for

Resident of City Council District No.:_I_ Are you an incumbent? Yes __ No X The City of Stockton uses email as the preferred method of communication regarding your application. Is this acceptable to you? Yes ~ No __ . If you have checked "No", please identify how you prefer to be contacted: ________ _

Email Address: 5tl>U\E LUc..lV\.o\lJ\Q.GVV\!i\d.com Employer Name r-- e,.."""\ ..... , II" e.-ci 5 \J s:D \' e .:A.. C--"- I!... V-EmployerAddress __________________________________ _

Voter Registration: The City of Stockton requires members of the City Council Salary Setting Commission, Civil Service Commission/Equal Employment Commission, and San Joaquin County Mosquito and Vector Control District to be registered voters of the City of Stockton. Please fill out the information below if you are applying for one of these positions so that your voter registration may be verified:

Name: ____________________________ _

Address:~ __________________ __

C1ty: __________ _ Zip Code: ____ __

Signature: ___________________ _

(Form adopted by City Council on 10-10-95; Revised 12113/10) C:IDocumenm and Setting,lbhuntor.OITYOfSTOCKTONIMy DooumentsI125665-1.doc

City of Stockton APPLICATION CONTINUED Page 20f5

How did you hear about the position? --,t\I=I2-::..\!j"".",--,~~-'-'~I='. ""a..~~",-"ezt:".!-_~v'-~t"~:t-L-!I..I..2C-""'-'\L'e:::. =::. ~-~ __

city Council Policy 100-2 states that board/commission members are required to attend meetings on a regular basis. If appointed, will you be able to altend meetings regularty and devote the time necessary to fulfill your duties as a member? Yes X No __

Do you or immediate t.amllY members have any rela~ship (professional, financial, other) that may present a potential conflict of Interest for this advisory group? Yes~. _ No Iryes, please explaln ________________________________ _


o 49-99 Cooperative Library System Advisory Board You must be a resident of San Joaquin County, but not the City of Lodi. Do you meet this requirement? liJ Yes 0 No

o Stockton Arts Commission O~I$lde of your profession indicate what type of Arts you are active in (circle any that apply): MUSic, Dance. Theater, Cinema, Photography, Architecture, Art Criticism, Textile Arts, Literary Arts, the Visual Arts, including (~ut not limited to) the Public or Environmental Arts, Graphic Arts, Design, Drawing, Painting, Printmaking, SculpkJre, Ceramics, and Art History Are you interested in or accomplished in fund-raising? 0 Yes 0 No

.liS) Building and Housing Boal"(! of Appeats/ Handicapped Access Board of Appeals Do you hava experience In any of tha follOwing areas (circle any that apply): General Building Contractor, Plumbing Conlractor, Elactrical Conlra2!9r, or Machanlcal Contractor, Enginaer or Archllec!. Are you a disabled citizen? ill> Yes 0 No

o Central Parking Oistrlct Advisory Board Do you own raal property or are you an axacutive officer of a corporation that owns raal proparty within the Central Parking Dislrict? [J Yes 0 No Specify property addressees): __________________ _

o Climate Action Plan Advisory Committee Do you aclivaly rapresent any of the following intaresl 91'9Ups wilhin the City of Stockton (circle any that apply): Environmental, Non-Profit Community Organlzalion, Labor, Business, Developer

o Cultural Heritage Board Are you knowiedgeable have experience in, or extensive backgro~nd in any of the following areas (circle any that apply): Hisloric or cultural traditions of the community, preservation, archlteclure, construclion technology, real-estate, construction indust\y, California licensed Architect, Historian, Stockton rasident for 40 years or longer.

o Development OVersight Commission Do you work in Stockton or with a firm/organization thaI does business in Stockton? 0 Yes 0 No State name/address of firm/organizatlon:=== _____________________ _ Are you any of the following (check anY that apply) o Local archltecVdesigner 0 Local Civil Engineer 0 Mixed Use Builder/Developer o Local Representative from publio at.large 0 Local Non Profit Builder/Developer o Port of Stockton Executive (CEO or Designea) 0 San Joaquin Partnership Exacutlve (CEO or Deslgnae) Building Industry Association 0 Executive (CEO or Designee) m: 0 Mixed Use Builder/Developer Builder's Exchange 0 Ex.culive (CEO or Designee) m: 0 General Contraclor

C:IDooumenls and Selllngs\bhunter.cITYOFSTOCKTONIMy Doc~ment61125665-1.doo (Form adopted by City Council on 10-10-95; ReVised 12-13-10)

City of Stockton APPLICATION CONTINUED Page 30f 6

o Port Commission Do you reside Within the Port District boundary or consistent With the Clly General Plan bOUndaries, plus a one-half mile stlip on either side of the stocklon Ship Channel from the Port to Disappointment Slough, If so for how long? ______ _

o Public Art Advisory Com mitt •• (circle any that apply) Employed as a professional visual artlsl, clitic of contemporary visual art forums, or have knoWiedge of, Or skill/experience in any of Ihe folloWing: activist for the visual environmenl, public art, regional/national IndiVidual artists work, underslanding of elhnlc/gender diversity, the stockton Public Art Plan processes and implications for the city, decision-making ability, WiJlingness to tolerale/promote change, new artistic & design expressions, communlly activities significant enough 10 confirm knoWledge of Issues and Individuals Within Ihe community. Must be a resident of stockton for at least 3yesrs.

~ San Joaquin Regional Transit District Board Have you resided Within the Transit District boun~alies for at least one year? I8Yes 0 No Are you a resident in the City of stockton? ijj Yes 0 No

o Sports Commission (circle any that apply) If you are not a resident of Stockton, do you own and/oroperale a bUsiness Wilhin Ihe Cily or are a sponsor or assoclaled With a sports relaled event, name of business or evenl(s): ___________________ _

o Stockton Measure W Oversight Committee Do you reside Wilhln stockton's geographic boundary? 0 Yes 0 No Are you at least 28 years of age? 0 Yes 0 No Are you an emplo)'ee of any vendor, contractor or oonsultant doing business Wilh the City of Siockton? 0 Yes 0 No

o Council Water Advisory Group Do you reside Within one of the Stockton MuniCipal Ulllilies' Ihree utility service areas? 0 Yes 0 No If so, stale Which one; _______________ _

o Youlh Advisory Commillee (fill in, circle, or check) High school enrolled In: Will you be a senior next commlHee lerm? DYes ONo Are you a member of one of the folloWing Community Centers? McKinlay, Seifert and Solrra Vista, Sinbloy and van Buskirk, olher. . Whloh Council Disllicl do you reside In? District CD 2, 3, 4, 6, or 6 (leave blank If you do not know).

BACKGROUND INFORMA nON

WORK EXPERIENCE: List names, addresses, and dates of employers for the lasl five (5) years. AUach additional sheets of paper if needed.

FROM: MO .. ___ ,DAY YEAR ___ ,EMPLOYER NAME._ ..... S=-V~S=-.=:tC...)::........._.7.' __ _ TO: MO. DAY YEAR ADDRESS'----::"""',..-__ -,-__ ---,fC.."_· ___ '-DUTIES: .... t;.1a f'- 'P"",d 2[)O (, ~(..7t.. cJ.-t eA"'-/~OfJIl7c1Dr-'"

/ (

FROM: MO. ___ ,DAY ____ YEAR. ___ .EMPLOYER NAME ___________ _

TO: MO. DAY VEAR __ ---'ADDRESS ______________ _

DUTIES: ____________________________ _

BUSINESS ENTERPRISES: Lisl business name, Including fictitious name anct address of any business enlerplises currenlly or previously owned or operated.

FROM: MO, __ DAY ___ YEAR BUSINESS NAME _______________ _

TO: MO. DAY YEAR __ ADDRESS _________________ _

C:\Documenls and SeHlngs\bhunter.CITYOFSTOCKTONIMy DocumentsI125665-1.doo (Form adolied by City Counoll on 10-10·96; Revlood 12" 13-10)

City of Stockton APPLICATION CONTINUED Page" of5

TYPE OF BU5INE:SS OR SERVICE RENDERED:

A resume reflecting experience, community activities, or olher qualifications not IIsled below may be attached In order to assist the Council in evaluating your application. (Optional)

EDUCATION: _--"-lb=::.... =S....!I_~ __ £_·· .:....:#\1'd"1----'-M-lo:-. -=.5,-,-, --=c:=-.!<:>'-()'--'-'\>\::....s"-'=e.""l ..... ,=~:=::<;:\==:;:o<.=:J

CONFLICT OF INTEREST: State and local law requires that you abstain from participation In decisions that may affect your financial interests, Including sources of income and interest in real property or investments. In addition, if appointed you may be required to fill out a disclosure statement that identifies certain of your financial interests beginning with the immediate twelvemonth periOd prior to yollr appolnlment. eased on your best judgment, does this board or commission make decisions that may affect any sources of income, Interests in real property, or Investments of you or yourspouse?

Yes __ No Y If yes, please explain. Identify any organizations, aSSOClatl.ons, corporations, or entities by which you are employed or~iated that might be affected by decisions of this board or commission and the positions you hold .. _________________________________ _


In accordance with Government Code Sections 87300 - 87313 end tha City of Stockton's Conflict of Interest Code, this BQard/Commlsslon/Commlttee may be designated to file Statements of Economic Interesls.

If you are appointed to this Board/Commission/Committee. you may be required to file statements disclosing certain types of Information so that the public can be made aware of potential connlcts of Interest. The types of disclosure are:

Investments Interests In Real Property (other than your residence) Interests In Real Property Held by a Business Entity or Trust Investments Held by a Business Entity or Trust Income (other than loans and gifts) Income - Travel Payments, Advances, Reimbursements Income Gifts Business Positions Commission Incomo Received by Brokers, Agents, and Salespersons Income and Loans to a Business Entity or Trust Income from Rental Property

If you have any questions regarding disclosure requirements, please contact the City Clerk's Office at 937·8458.

CONVICTIONS: Conviction of a crime is not necessarily a bar 10 appointment. Each case is considered separately based on requirements of the position; however, failute to list convicllons may rasuil in disqualification.

1. Have you eVer been convicted of a felony? If yes, please explain:

No 2. List each civil action, if any, in which punitive or exemplary damages have been assessed against you, Indicating in each

Instance ihe date olthe trial, courljudgment and the location olthe court Which rendered the judgment:

C:IDocument. and Selllngslbhunter.CITYOFSTOCKTONIMy DocumentsI125665-1.doc (Form adopted by City Council on 10-10-95; Revised 12-13-101

CJty of Stockton APPLICATION CONTINUED Page 50f6

luc.I~~~ SOO[.e-APPLICANT NAME

I DECLARE, UNDE:R PENALTY OF DJSQUALIFICATION AND TERMINATION, THAT ALL STATEMENTS IN THIS APPLlCATD:t-J ARE TRUE AND COMPLETE: TO. THE BE:ST OF MY KNOWL~ ,

Signature JCP~e~7 Date;:3 ~ ~ - ~3 Please identify any specialized accommodations needed for equal participation: __ ~IU"-,,,o,-,ti,-,-...:-e:-=--_______ _

The following Infonnation is vOluntary and Is gathered in accordance with State and Federal laws ~the purpose of evaluating the effectiveness of our Afflnnative Action and recruitment efforts. Please check: ~ .. _Male .. ~ Female

2(lfVhite (Not Hispanic Origin) All persons having origins In any of the original peoples of Europe. North Afnca or the Middle East

_Black (Not Hispanic Origin) All persons having origins In any of the Black racial groups of Africa.

_Hispanic All persons of Mexican. Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless Of race.

_Amerioan Indian or Alaska Native All persons having origins in any of the original peoples of North Amenca and who maintain cultUral identifiCations through tribal affiliation or community recognition. Please Identify your tribal affiliation.


_Asian

The Stockton City Council appoints members to the various City of Stockton Boards and Commissions. The Council also appoints representatives to serve on various other San Joaquin County agencies as well. Please check the boxes belOW if you are interested in serving on any other boards/commissions. To find out about what these boards/commissions do and if you qualify, please visit the City of Stockton webSite at www.stooktongov.com/oommissions

049-99 Cooperative Library System Advlsol)' Board

DArts Commission

OBuliding and Housing Board of Appeals

OCantral Parking Dislrict Advisory Board

OCity Council Salal)' Setting Commission

OClvll Servloe and Equal Employment Commissions

OClimate Action Plan Advisol)' Committee

OCommunity Development Commlttae

OCullural Heritage Board


Jal,Handicapped Access Board of Appeals

OMeasur. W Overolght Committee

OParks and Recreation Commission


o Port Commission

o Public Art Advisol)' Committee


I.1!i San Joaquin County Commission on Aging

o San Joaquin County MosqUito And Vector Control District

J1iJS.n Joaquin Regional Transit District Board

OSports Commission

o Water Advisol)' Group

o youth Advisory Commission (must be in high school to serve on this Commission)

colDeculllents and SeUingslbhunter.CITYOFSTOCKTONIMy Doouments\12S665-1.doc (Form adopted by City Council on 10-10-95; Revised 12-13-10)