City of San Antonio Application for Appointment
Board/Commission/Committee
Select board or commission from dropdown listing --------------> Affirmative Action Advisory Committee Air Transportation Advisory Commission Animal Care Services Advisory Board Arts and Cultural Advisory Committee Bexar County Appraisal District Bexar Metro 911 Board of Adjustment Brooks Development Authority Building and Fire Code Board of Appeals Capital Improvements Advisory Committee Citizen Advisory Action Board City Commission on Veterans Affairs City Council Committee on Boards and Commissions City of San Antonio Texas Education Facilities Corporation City Public Service Board City South Management Authority Commission for Children and Families Community Action Advisory Board Community Development Advisory Committee (CDAC) Conservation Advisory Board Convention and Visitors Commission Crime Control and Prevention District, San Antonio Crime Prevention Commission Dangerous Structure Determination Board Disability Access Advisory Committee Downtown Advisory Board Electrical Supervisory Board Employee Management Committee Empowerment Zone Governance Board Ethics Review Board Fire Fighters' and Police Officers' Civil Service Commission Fort Sam Houston Community Advisory Board Head Start Policy Council Historic and Design Review Commission Joint City/County Citizens Bond Oversight Commission Joint City/County Commission on Elderly Affairs Keep San Antonio Beautiful Inc. Linear Creekway Parks Advisory Board Mayor's Ad Hoc Audit Committee Mayor's Commission on the Status of Women Mechanical Board of Appeals Municipal Civil Service Commission Municipal Court Advisory Committee Municipal Golf Association - SA (MGA-SA) Noise Abatement Advisory Committee Parks and Recreation Board Planning Commission Plumbing Appeals and Advisory Board Port Authority of San Antonio River Commission RiverWalk Capital Improvements Advisory Board San Antonio Commission on Literacy San Antonio Development Agency (Urban Renewal Agency) San Antonio Housing Authority San Antonio Housing Finance Corporation San Antonio Housing Trust Board of Trustees San Antonio Local Development Company, Inc. (d/b/a South Texas Business Fund) San Antonio Metropolitan Health District Advisory Board San Antonio Public Library Board of Trustees San Antonio Water System Board of Trustees (SAWS) Small Business Advocacy Committee Transportation Advisory Board VIA Metropolitan Transit Authority Watershed Improvement Advisory Committee Westside Development Corporation Zoning Commission
Category If Applicable
Name:
Address:
Phone
Fax
E-Mail
Employer
Occupation:
Are you or can you be qualified to vote in a City of San Antonio Election? Yes No
Are you a City of San Antonio resident? Yes No How Long?
In which City Council District do you reside? District 1 District 2 District 3 District 4 District 5 District 6 District 7 District 8 District 9 District 10 How Long?
Have you ever represented any other private person, group or entity for compensation before the City Council or any department, commission, board or committee of the City within the last three years?
Yes No
Do you, your spouse, or your employer have any financial interest, direct or indirect, in any contract with the City (including serving as an Administrative Aide to a Council member)?
Do either you, your spouse, or your employer have any financial interest, directly or indirectly, in the sale to the City of any land, materials, supplies or service?
Do you have any litigation pending or completed within the last 12 months, either personally or professionally, that would affect your ability to fulfill the functions of the board or commission, if selected?
If Yes, please describe:
Have you ever been convicted of violating any federal, state or municipal law, regulation or ordinance?
If Yes, give details. Do not include traffic violations.
BACKGROUND
Education:
Professional:
Volunteer Experience/Community Service:
Areas of interest:
Have you ever been hired for a position with the City?
If Yes, list the department(s) and date(s):
Reason for leaving City employment
Please specify membership on any other governmental Board/Commission/Committee.
List all boards, commissions, corporations, non-profit entities, agencies, or other entities of which you are a member and/or officer and/or employed by, and give the title and dates of any position which you have held in such organization.
Please provide a brief narrative outlining your reasons for seeking appointment to a board or commission
Appointment to boards, commissions or committees include allowance for proper representation to reflect the ethnic and gender makeup of the community. Please select the appropriate codes:
ETHNIC CODE: W=Non-Minority H=Hispanic B=African American P=Asian or Pacific Islander O=Other I=American Indian/Alaska Native Aleutian
W=Non-Minority H=Hispanic* B=African American P=Asian or Pacific Islander O=Other I=American Indian/Alaska Native Aleutian * = Note that Hispanic includes all persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin regardless of race.
GENDER CODE: M=Male F=Female
M=Male F=Female
As a board, commission, or committee member, you will be asked to adhere to:
Code of Ordinances, City of San Antonio, Part II, Chapter 2, Article IX, Sec. 2-534
All board and commission members must file a financial disclosure report with the office of the city clerk upon appointment, and annually thereafter, throughout the member's term. Failure to file a financial disclosure report within the time required by the city's ethics code will be considered an automatic removal.
CONSENT FOR CITY TO CONDUCT A SEARCH OF CRIMINAL HISTORY RECORDS AND RELEASE OF PUBLIC INFORMATION
I hereby state that all of the information in this application for appointment is true and correct. I further request, as a part of my application, that all law enforcement officials and criminal justice agencies release any criminal history records concerning me to the Office of the City Clerk of the City of San Antonio in order that qualifications may be checked. I understand that if any member of the public makes a request for information included in this application for appointment, most of the information must be disclosed under the Public Information Act. I understand that the City of San Antonio will attempt to maintain the confidentiality of highly private matters by seeking an Attorney General’s opinion in accordance with the Public Information Act. I understand that it may not be legally possible to maintain the confidentiality of such information, and I hereby release the City of San Antonio, and its agents, employees and officers, from any and all liability whatsoever if the information must be released pursuant to the Public Information Act or any other law requiring its release.
I have read and understand the guidelines set out in this application. The foregoing statements are true, accurate and complete; and I agree that any misrepresentation or omission of facts may result in my disqualification for appointment.
Note: All information provided herein or pursuant hereto is considered public record upon receipt.