HEAR Commission (Wait List)

2. Description:
   The purpose of the HEAR Commission is to advance and advocate for equity, access, diversity, social justice, safety, mutual appreciation, increased cultural competency, positive inter-group relations and respect for all members of the San Gabriel community.
4. The HEAR Commission serves as an advisory body to the City Council and reports directly to the City Council to assess and recommend policies, procedures and activities in the City government to advance the Commission’s purpose. The HEAR Commission is not an oversight board nor a body whose primary function is to receive or investigate individual incidents or complaints. The HEAR Commission may request and obtain information with respect to individual incidents or complaints, but only to the extent necessary to make policy, procedure or activity recommendations to the City Council.
6. Meetings
   Meetings will occur monthly at a time and place to be determined by the City Council.
8. 1. Personal Data
   Please enter your personal data below.
10. First Name*
11. Last Name*
13. Phone Number*
14. Email: *
16. Home Address*
17. City*
18. State*
19. Zip*
21. Name of Employer
23. Work Address
24. City
25. State
26. Zip
28. 2. Work Experience
31. Describe your duties:
33. 3. Education and Training
35. Please comment on your education and training as it may relate to your application:
37. 4. Please enter your professional licenses, certifications or registrations:
39. 5. Please enter your personal and community affiliations:
41. 6. Briefly explain why you are interested in serving on this Commission:
43. 7. Please share any personal experience, education or activities that demonstrate your interest in advancing the Purpose of the HEAR Commission.
45. 8. Do you have any restrictions pertaining to meeting attendance?

    1. Yes
    2. No
47. If yes, please explain:
49. 9. Do you or an immediate family member have any professional or financial relationship that may present a potential conflict of interest for this commission?

    1. Yes
    2. No
51. If yes, please explain:
53. Pursuant to the City's Conflict of Interest Code, members are required to file a Statement of Economic Interests (Form 700). Members are also required to complete AB1234 Ethics Training within one year of appointment and every two years thereafter.
55. Are you willing to file a Statement of Economic Interests and complete AB1234 Ethics Training as required?*

    1. Yes
    2. No
57. References - Please provide three personal/professional references
59. 1. Name
60. Phone number:
62. Address
63. City
64. State
65. Zip
67. Reference Type*
    -- Select One --Professional ReferencePersonal Reference
69. 2. Name
70. Phone number:
72. Address
73. City
74. State
75. Zip
77. Reference Type*
    -- Select One --Professional ReferencePersonal Reference
79. 3. Name
80. Phone Number:
82. Address
83. City
84. State
85. Zip
87. Reference Type*
    -- Select One --Professional ReferencePersonal Reference
89. Disclosure
    Please note that this is a record that is subject to disclosure under the California Public Records Act.
91. You may attach a resume and/or additional pertinent information.
Leave This Blank:


93. 1. Receive an email copy of this form.
94. Email address

    This field is not part of the form submission.

95. Submit Submit and Print

* indicates a required field