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Applicant: Michael Ward, supplemental-33384

Supplemental Application for Citizens Redistricting Commission

  • Name: Michael Ward
  • City: Anaheim, ca

Submission Timestamp: 04/19/2010 10:35:13

Part 1: Essay Questions:

The responses to the essay questions are limited to no more than 3200 characters including spaces (approximately 500 words) per essay question. You may cut and paste text from any word processing program such as Microsoft Word.

1. Please describe why you are interested in serving on the Citizens Redistricting Commission.

My interest in seeking to serve the great state of California by participating in the Citizens Redistricting Commission is multi-faceted and of real importance to me. As a Special Agent with the United States Air Force, I have had occasion to travel to almost every continent and I have lived in many major regions of the United States. No place I have travelled is as rich both culturally and geographically as California. Thus, I have established permanent roots in Southern California and have a vested interest in the economic success, preservation, legislative transparency and social equality of the state I call home.

First and foremost, I am proud to be the uncle of four year old twin boys, a three year old boy, and a new 7 month old girl all of whom live in my immediate area. These are my most prized treasures and they will grow up in California schools, play at California beaches and get their first job in California. Nothing is more important to me than doing everything I can to ensure that they grow up in the same vibrant state that I did, full of opportunity and diversity in thought and expression.

As a proprietor of a small business and health care provider I am directly impacted by California’s governance. My livelihood and that of my family, friends and patients are completely dependant and shaped by the merited and balanced leadership and administration this state strives to attain.

Playing any role in ensuring that every citizen of this golden state has an equal and honest chance to have their voices and interests heard is a great calling and one that I have a genuine, passionate and subjective interest in. I am no stranger to service of country, community, church and family. I believe in service before self and my life’s work so far is evidence of this commitment.

California has a momentous history of pioneering social awareness and fairness for all Americans. As a disabled veteran and a registered tribal member of the Choctaw Indians, I understand how crucial it is that all have parity in participating in the elective process for state representation. Considering the ongoing economic challenges that face California, it is more important than ever that citizens have full confidence and understanding that their legislature has been appropriately and fairly elected to represent their needs and that all have equal access to participate in the election process.

For all these reasons listed, I believe that becoming a functioning member of California’s Citizens Redistricting Commission offers the preeminent opportunity to safeguard continued achievement, success and prosperity for all Californians.

2. Please describe your ability to be impartial, as discussed in Regulation 60800. You may include with this description any occupational, academic, volunteer, or other life experiences you have had that demonstrate this ability.

One of the most important aspects of a working member of this citizen commission is the practical application of remaining impartial while determining districting issues and working with fellow panel members. I have a long track record of being in both professional and personal settings that require unprejudiced decision making and analysis.

As a former law enforcement official, one of the services I perform currently is conducting polygraph exams for the local police department. The very nature of being successful at polygraphy is being able to be impartial and interpret a persons raw physiology as objectively recorded despite what feelings you might have about the crime or the background/demeanor of the person testing. I am an American Polygraph Association member, which is a designation only given to those in the polygraph field with a thoroughly vetted history of performing unbiased, fair and scientifically validated testing. Having dealt with many people accused of various crimes and indiscretions, I have seen first hand how bias can erroneously shape decision making. In polygraphy, there is no room for preconception as the outcome has literal life implications for all involved. I pride myself on my proven, broad and verifiable background of impartiality and objectivity.

As a Special Agent, I was in charge and lead investigator on hundreds of general crime and narcotics cases. The ability to respect all walks of life and push personal judgments aside and ensure equal assistance for all is a daily practice. I have a highly decorated record of being an impartial fact finder and disinterested decision maker. One case that really drove home the importance of open-mindedness was a night when I was called to respond to a reported rape. The victim was very intoxicated and had passed out on some rocks. She reported to have been dumped there after being assaulted, but the local police declined to investigate saying her injuries were from passing out on rugged ground. I chose to fully process the scene despite her unclear memory, inebriated state and obvious indigent status. A man weeks later admitted to a bar buddy that he had assaulted a woman in that area. Evidence collected as a result of giving this allegation the same due as any other, was able to lead to a conviction and justice validating the victimization of that woman. It would have been easy to dismiss her claim due to irrelevant circumstances, but that would have been judgmentally wrong.

I have absolutely no political ties, commitments or aspirations whatsoever, thereby making me free of any undone influence that might impede my objectivity. I also have no stake in the outcome of any redistricting decisions other than a profound desire to ensure fairness and appropriate representation for California’s entire electorate.

3. Please describe your appreciation for California’s diverse demographics and geography, as discussed in Regulation 60805. You may include with this description any occupational, academic, volunteer, or other life experiences you have had that demonstrate this appreciation.

Being a California native, I have had occasion to visit and enjoy a large portion of California’s state parks and beaches. California is also the lead dairy state, strategic oil producer and the world’s fifth largest supplier of agriculture. California depends on the proper representation and preservation of these vast resources and their specialized communities as they are integral to this states economy, the nations largest.

As a registered tribal member of the Choctaw Indian Tribe (American Indians represent approximately 1.6% of the states demographic), I appreciate the important relationship between the natural resources of this great state and its people whom are equally diverse and essential. Since California is the most populous state, it is critical that the electoral process be transparent, easily understood and beyond reproach in fairness. Considering California is an international leader in many key regards do to its abounding diversity, I understand the responsibility of ensuring that each unique region and demographic be comparatively heard and appropriately represented.

Being a health care provider, I impartially and respectfully provide comfort to people of all nationalities, socioeconomic backgrounds, and mental capacity equally. What has become clear is that each of the multitude of communities that contribute to the fabric of this state have different needs and require suitable representation. That is why, in my opinion, a key component of a member of this Commission will be to understand that the states’ districts must be common-sensical and uncomplicated in nature as to attract maximal participation from within all demographics and interests in the electorate. California directly benefits from its prolific diversity, and therefore it is critical that a member of this Commission respects that relationship enough to ensure evenhandedness throughout the redistricting process.

As a volunteer health care provider at the West Hollywood free clinic providing pain relief to HIV positive patients, to volunteering at the Los Angeles Dream Center which is charged with rehabilitating wayward youth, I have come to believe that this Redistricting Commission can provide a fresh optimism to those that might feel muted. Thereby demonstrating California’s commitment to giving an appropriate voice and consideration to all its citizens and their interests. Having participated in numerous religious and relief missions trips to other countries, I have intimate involvement with sectors of societies that have no declaration, no options and no embodiment in their government. Despite my personal beliefs on any given issue, these experiences have impressed my heart with a devout conviction that all people and circumstances deserve adequate opportunity to shape the policy that affects their life as Californians. I hope to bring this tested and experienced ability of even-handedness to service with this Commission.

4. Please describe the analytical skills you have that are relevant to serving on the Citizens Redistricting Commission, as discussed in Regulation 60827. You may include with this description any occupational, academic, volunteer, or other life experiences you have had that demonstrate those skills.

The mission of redistricting California is no easy task. I possess the perfect mix of life experience, academic achievement and professional prowess that such a charge demands. As a Special Agent investigating crime scenes for 6 years, I have expanded practice at stepping into unknown situations carefully developing, inspecting and recording massive amounts of information and interpreting that data into an evidence based conclusion. Professional skills included determining if a crime had been committed, independently researching the relevant legal codes and proving all ‘elements of proof’ listed under their respective US criminal codes. Valuable familiarity in dealing with lawyers, interpreting and applying their opinions and testifying in court under oath was gained. Of course, communication skills were critical to success. Understanding how to speak with and listen to all types of people whether, victim, witness, suspect, lawyer or other agency was imperative to proper resolution. One of my most recognized skill sets was my written and oral communication skills. Written reports detailing all aspects of an investigation were the only product sent to United States Attorneys to assess for prosecution. If that report was not easy to read, concisely detailed and effective at simplifying often complex and convoluted circumstances then the case would likely not end in prosecution. I lead my detachment in case load, and cases prosecuted. This was attributed in decoration citations as due largely to my thorough analytical approach and ability to communicate. I was also chosen out of 400 applicants as one of 5 ‘Command Briefers’ responsible to deliver statements and presentations to media, dignitaries or other interested parties. Graduating in the top ten percent of every academic undertaking I have endeavored, I have an education background that is steeped in research, self-study, information organization and analytical dimension. Completing a medical program required passion and endurance, as well as a commitment to make a difference. Practicing health care demands expert listening skills, ability to find and interpret physical deficiencies and accurately interpret and rank order their importance to determine effective remedies. Finally, being able to effectively communicate complicated physiological concepts to patients of all aptitudes is a polished skill employed daily. An example of a time I was tasked to lead a group of ten occurred when as a First Lieutenant I was instructed to examine how threat information was reported and disseminated globally for the Department of Defense (DoD). After careful examination, I recommended creating a ‘DoD global threat watch center’. Having no experience in building such a program, I garnered a team, visited numerous command posts and delegated research, legal and data acquisitions taskings Team meetings were held to develop and implement an operational and logistical strategy. Within 2 years the project was complete, ahead of schedule and fully operational. This led to a central dumping ground for all threat data world wide and allowed experts to provide immediate threat assessment.

Part 2: General Information

Education

Yes No
Did you graduate from high school?
If not, do you possess a GED or equivalent?
If not, enter the highest grade you completed:

University or College, Business, Correspondence, Trade, or Service School(s) Attended

School Name and Location: Southern California University of Health Sciences
Course of Study/Major: Sports Medicine / Chiropractic Science
Diploma, Degree, or Certificate Obtained: Doctorate of Chiropractic
Date Completed, If Completed: April 2006
Number of Years Attended: 4

School Name and Location: California State University Fullerton, Fullerton CA
Course of Study/Major: Communications / Public Relations
Diploma, Degree, or Certificate Obtained: Bachelor of Arts
Date Completed, If Completed: June 1997
Number of Years Attended: 5

Employment History

  • Begin with your most recent job.
  • List each job separately.
  • Employment history must include at least 10 years. Employment job classifications may include retired, volunteer, not employed outside the home, or not employed. Please account for all of your time during the past 10 years.
  • Include all employment history you believe is relevant beyond 10 years.

From: 2006
To: present
Employer Name: Robert Renfro
Title/Job Classification (Include Range or Level, if applicable): Doctor of Chiropractic
Total Worked (Years/Months): 3 years 4 months
Description of Duties Performed*:

Responsible for all areas of patient healtcare including:

Exam, diagnosis, rehabilitation, treatment plan development, care management, documentation assurance.

I do not accept workers compensation claims and do not participate or make any money from state workers compensation program.

From: 2002
To: 2006
Employer Name: Southern California University of Health Sciences
Title/Job Classification (Include Range or Level, if applicable): Student
Total Worked (Years/Months): full time
Description of Duties Performed*:

Student completing a full time medical program.

From: 1997
To: 2002
Employer Name: United States Air Force
Title/Job Classification (Include Range or Level, if applicable): Special Agent
Total Worked (Years/Months): 5
Description of Duties Performed*:

Directed all facets of complex criminal, fraud and counterintelligence investigations with specialized training in computer forensics, electronic media analysis and contracting/financial fraud. Created infrastructure to perform a continuous global watch for imminent threat information assessment.

* In your current employment, if you serve as staff to, or a consultant to, or are under contract with the Governor of California, a member of the California Legislature, a California member of Congress, or a member of the State Board of Equalization you must disclose that here.

Activities:

Describe the professional, social, political, volunteer, and community activities in which you have engaged that you believe are relevant to serving as a commissioner, as discussed in Regulation 60847. The responses to this question are limited to no more than 3200 characters including spaces (approximately 500 words). You may cut and paste text from any word processing program such as Microsoft Word.

The following is a list of all past and present organized associations:

American Polygraph Association – Active Member

American Chiropractic Association – Active Member

Choctaw Nation of Oaklahoma – Active Member

Disabled American Veterans – Member

Golden Key National Honors Society – Member

Delta Tau Alpha Honors society – Member

Delta Sigma Honorary Scholastic Society of the Healing Arts – Member

National Board of Chiropractic Examiners – Member

Eastside Serving Others (formal church provision outreach) – Member/Organizer

Fullerton Rotary Club – non-member participant

Criminal History

Have you ever been convicted by any court of a felony?


If yes, please provide the following information:

Date:
Court:
Location:
* Offense (other pertinent information):

* If known, include the reference to the statute under which you were convicted (i.e. Penal Code section 424).

Voting Information

When you voted in any of the last three statewide general elections (i.e. the elections in November 2004, November 2006, and November 2008), did you vote using a different name or address than your current name or address?


Former Residences

List all of the places you have lived for 30 days or more at one time during the last 10 years (but list no information for where you lived prior to your 18th birthday). This does not include your current residence. If you lived in temporary housing while permanently residing somewhere else, note that with an * in the address line.

From Date: 2006
To Date: present
City, State, Zip Code: fullerton, ca, 92832
County (or Country if Outside the United States): orange

From Date: 2006
To Date: 2002
City, State, Zip Code: Anaheim, CA 92806
County (or Country if Outside the United States): orange

From Date: 1999
To Date: 2002
City, State, Zip Code: Upper Marlboro, MD, 20772
County (or Country if Outside the United States): Prince Georges

Financial Contributions

List all of the monetary and non-monetary contributions of $250 or more that you have made in any single calendar year during the past 2 years to any professional, social, political, volunteer, and community organizations and causes. Begin with your most recent contribution.

Date of Contribution, if known: 2010
Organization: Eastside Christian Church
Location: Fullerton, CA
Amount: $300

Part 3: Family Information

You must provide information about each living family member described in this paragraph. Information about each applicant’s family members is necessary to determine whether an applicant has a conflict of interest that would prohibit the applicant from serving on the commission. In this part of the application, you must provide information about your living parents, spouse, registered domestic partner (RDP), children, siblings, parents in-law, siblings in-law, sons and daughters in-law. Step-parents, step-children, and step-siblings count as parents, children, and siblings.

Do you have any family members as described above?


You are required to list information for each family member in a separate set of fields. The relationship, name, occupation, and employer may be posted on the Internet as explained in the privacy statement contained in this application. No other information will be posted on the Internet.

Name: Bill Ward
Relationship: Parent

For this family member, you must state whether within the past 10 years the person has engaged in any of the activities that could cause you to have a conflict of interest under the Voters FIRST Act. The following is a list of those activities:

  • Been appointed to, elected to, or a candidate for a California congressional or state office. (“Appointed” means appointed by the Governor, a member of the Legislature, or a member of the State Board of Equalization, or served at the pleasure of the Governor, a member of the Legislature, or a member of the State Board of Equalization.)
  • Served as an officer, employee, or paid consultant of a California political party or the campaign committee of a candidate for a California congressional or elective state office.
  • Served as an elected or appointed member of a political party central committee operating in California.
  • Been a lobbyist registered with the State of California or a California local government.
  • Been a registered federal lobbyist.
  • Served as paid California congressional, legislative, or State Board of Equalization staff.
  • Contributed $2,000 or more during a calendar year to any California congressional, state, or local candidate for elective public office.
Within the past 10 years, has this family member engaged in any of the activities listed above that could cause you to have a conflict of interest?: Yes   No
If you answered “Yes” to the last question:
– When did the activity occur?:
– What was the activity?:

For each family member you must indicate whether you have a special (bona fide) relationship with that person. You have a special (bona fide) relationship with a family member if during the past 12 months you have (Guidance on Conflicts of Interest):

  1. Resided with that person for a period or periods totaling 30 days or more (Examples).
  2. Shared with that person ownership of any real or personal property having a total value of $1,000 or more (Examples).
  3. Provided to or received from that person a financial benefit totaling $1,000 or more (Examples).
Do you have a special relationship with this person based on any of the three factors described above?: Yes   No

Name: Pat Ward
Relationship: Parent

For this family member, you must state whether within the past 10 years the person has engaged in any of the activities that could cause you to have a conflict of interest under the Voters FIRST Act. The following is a list of those activities:

  • Been appointed to, elected to, or a candidate for a California congressional or state office. (“Appointed” means appointed by the Governor, a member of the Legislature, or a member of the State Board of Equalization, or served at the pleasure of the Governor, a member of the Legislature, or a member of the State Board of Equalization.)
  • Served as an officer, employee, or paid consultant of a California political party or the campaign committee of a candidate for a California congressional or elective state office.
  • Served as an elected or appointed member of a political party central committee operating in California.
  • Been a lobbyist registered with the State of California or a California local government.
  • Been a registered federal lobbyist.
  • Served as paid California congressional, legislative, or State Board of Equalization staff.
  • Contributed $2,000 or more during a calendar year to any California congressional, state, or local candidate for elective public office.
Within the past 10 years, has this family member engaged in any of the activities listed above that could cause you to have a conflict of interest?: Yes   No
If you answered “Yes” to the last question:
– When did the activity occur?:
– What was the activity?:

For each family member you must indicate whether you have a special (bona fide) relationship with that person. You have a special (bona fide) relationship with a family member if during the past 12 months you have (Guidance on Conflicts of Interest):

  1. Resided with that person for a period or periods totaling 30 days or more (Examples).
  2. Shared with that person ownership of any real or personal property having a total value of $1,000 or more (Examples).
  3. Provided to or received from that person a financial benefit totaling $1,000 or more (Examples).
Do you have a special relationship with this person based on any of the three factors described above?: Yes   No

Name: Melissa Hansen
Relationship: Sibling

For this family member, you must state whether within the past 10 years the person has engaged in any of the activities that could cause you to have a conflict of interest under the Voters FIRST Act. The following is a list of those activities:

  • Been appointed to, elected to, or a candidate for a California congressional or state office. (“Appointed” means appointed by the Governor, a member of the Legislature, or a member of the State Board of Equalization, or served at the pleasure of the Governor, a member of the Legislature, or a member of the State Board of Equalization.)
  • Served as an officer, employee, or paid consultant of a California political party or the campaign committee of a candidate for a California congressional or elective state office.
  • Served as an elected or appointed member of a political party central committee operating in California.
  • Been a lobbyist registered with the State of California or a California local government.
  • Been a registered federal lobbyist.
  • Served as paid California congressional, legislative, or State Board of Equalization staff.
  • Contributed $2,000 or more during a calendar year to any California congressional, state, or local candidate for elective public office.
Within the past 10 years, has this family member engaged in any of the activities listed above that could cause you to have a conflict of interest?: Yes   No
If you answered “Yes” to the last question:
– When did the activity occur?:
– What was the activity?:

For each family member you must indicate whether you have a special (bona fide) relationship with that person. You have a special (bona fide) relationship with a family member if during the past 12 months you have (Guidance on Conflicts of Interest):

  1. Resided with that person for a period or periods totaling 30 days or more (Examples).
  2. Shared with that person ownership of any real or personal property having a total value of $1,000 or more (Examples).
  3. Provided to or received from that person a financial benefit totaling $1,000 or more (Examples).
Do you have a special relationship with this person based on any of the three factors described above?: Yes   No

Name: Jason Hansen
Relationship: Brother or Sister in-law: Spouse/RDP of Sibling

For this family member, you must state whether within the past 10 years the person has engaged in any of the activities that could cause you to have a conflict of interest under the Voters FIRST Act. The following is a list of those activities:

  • Been appointed to, elected to, or a candidate for a California congressional or state office. (“Appointed” means appointed by the Governor, a member of the Legislature, or a member of the State Board of Equalization, or served at the pleasure of the Governor, a member of the Legislature, or a member of the State Board of Equalization.)
  • Served as an officer, employee, or paid consultant of a California political party or the campaign committee of a candidate for a California congressional or elective state office.
  • Served as an elected or appointed member of a political party central committee operating in California.
  • Been a lobbyist registered with the State of California or a California local government.
  • Been a registered federal lobbyist.
  • Served as paid California congressional, legislative, or State Board of Equalization staff.
  • Contributed $2,000 or more during a calendar year to any California congressional, state, or local candidate for elective public office.
Within the past 10 years, has this family member engaged in any of the activities listed above that could cause you to have a conflict of interest?: Yes   No
If you answered “Yes” to the last question:
– When did the activity occur?:
– What was the activity?:

For each family member you must indicate whether you have a special (bona fide) relationship with that person. You have a special (bona fide) relationship with a family member if during the past 12 months you have (Guidance on Conflicts of Interest):

  1. Resided with that person for a period or periods totaling 30 days or more (Examples).
  2. Shared with that person ownership of any real or personal property having a total value of $1,000 or more (Examples).
  3. Provided to or received from that person a financial benefit totaling $1,000 or more (Examples).
Do you have a special relationship with this person based on any of the three factors described above?: Yes   No

Name: Josh Ward
Relationship: Sibling

For this family member, you must state whether within the past 10 years the person has engaged in any of the activities that could cause you to have a conflict of interest under the Voters FIRST Act. The following is a list of those activities:

  • Been appointed to, elected to, or a candidate for a California congressional or state office. (“Appointed” means appointed by the Governor, a member of the Legislature, or a member of the State Board of Equalization, or served at the pleasure of the Governor, a member of the Legislature, or a member of the State Board of Equalization.)
  • Served as an officer, employee, or paid consultant of a California political party or the campaign committee of a candidate for a California congressional or elective state office.
  • Served as an elected or appointed member of a political party central committee operating in California.
  • Been a lobbyist registered with the State of California or a California local government.
  • Been a registered federal lobbyist.
  • Served as paid California congressional, legislative, or State Board of Equalization staff.
  • Contributed $2,000 or more during a calendar year to any California congressional, state, or local candidate for elective public office.
Within the past 10 years, has this family member engaged in any of the activities listed above that could cause you to have a conflict of interest?: Yes   No
If you answered “Yes” to the last question:
– When did the activity occur?:
– What was the activity?:

For each family member you must indicate whether you have a special (bona fide) relationship with that person. You have a special (bona fide) relationship with a family member if during the past 12 months you have (Guidance on Conflicts of Interest):

  1. Resided with that person for a period or periods totaling 30 days or more (Examples).
  2. Shared with that person ownership of any real or personal property having a total value of $1,000 or more (Examples).
  3. Provided to or received from that person a financial benefit totaling $1,000 or more (Examples).
Do you have a special relationship with this person based on any of the three factors described above?: Yes   No

Name: Kathy Ward
Relationship: Brother or Sister in-law: Spouse/RDP of Sibling

For this family member, you must state whether within the past 10 years the person has engaged in any of the activities that could cause you to have a conflict of interest under the Voters FIRST Act. The following is a list of those activities:

  • Been appointed to, elected to, or a candidate for a California congressional or state office. (“Appointed” means appointed by the Governor, a member of the Legislature, or a member of the State Board of Equalization, or served at the pleasure of the Governor, a member of the Legislature, or a member of the State Board of Equalization.)
  • Served as an officer, employee, or paid consultant of a California political party or the campaign committee of a candidate for a California congressional or elective state office.
  • Served as an elected or appointed member of a political party central committee operating in California.
  • Been a lobbyist registered with the State of California or a California local government.
  • Been a registered federal lobbyist.
  • Served as paid California congressional, legislative, or State Board of Equalization staff.
  • Contributed $2,000 or more during a calendar year to any California congressional, state, or local candidate for elective public office.
Within the past 10 years, has this family member engaged in any of the activities listed above that could cause you to have a conflict of interest?: Yes   No
If you answered “Yes” to the last question:
– When did the activity occur?:
– What was the activity?:

For each family member you must indicate whether you have a special (bona fide) relationship with that person. You have a special (bona fide) relationship with a family member if during the past 12 months you have (Guidance on Conflicts of Interest):

  1. Resided with that person for a period or periods totaling 30 days or more (Examples).
  2. Shared with that person ownership of any real or personal property having a total value of $1,000 or more (Examples).
  3. Provided to or received from that person a financial benefit totaling $1,000 or more (Examples).
Do you have a special relationship with this person based on any of the three factors described above?: Yes   No

Other Relevant Material:

Describe any other relevant information that you consider important that was not otherwise requested in the application. The responses to this question are limited to no more than 3200 characters including spaces (approximately 500 words). You may cut and paste text from any word processing program such as Word.

Current Licenses:

California License to Practice Chiropractic

Emergency Medical Technician – Basic

Registered Trigenics Physician

Part 4: Letters of Recommendation

An applicant must submit or arrange for the submission of three letters of recommendation from individuals or organizations. A letter of recommendation may be no longer than two pages. A description of the elements of a letter of recommendation is provided at the bureau’s web site. (Note: A public comment submitted about you will not count as a letter of recommendation.)

An applicant shall submit the required letters of recommendation to the bureau on or before April 19. Applicants shall submit the letters of recommendation to the bureau via e-mail to votersfirstact@auditor.ca.gov, or by facsimile, United States mail, or other common carrier. Letters of recommendation received by the bureau after April 19 will not be considered, and the applicant will not continue on in the application process.

On all of your letters of recommendation, you must include your application ID, which is 33384. The identification number is unique to your application and insures that each of your letters of recommendation is correctly attached to your application file before it is reviewed by the Applicant Review Panel. The letters of recommendation may be addressed to the Applicant Review Panel and can be mailed to 555 Capitol Mall, Suite 300, Sacramento, CA, 95814 in care of the State Auditor. They may also be faxed to 916-319-9295 or e-mailed to votersfirstact@auditor.ca.gov. E-mail is the preferred method of delivery.

Part 5: Financial Disclosure Form

If likely to be selected for an interview, you will be required to submit FPPC Form 700, Statement of Economic Interests. You do not need to submit that form now.

Part 6: PRIVACY NOTIFICATION AND WAIVER

LEGAL AUTHORITY AND REASON FOR COLLECTION OF PERSONAL INFORMATION

The Voters FIRST Act (the Act) and the regulations implementing the Act require that the selection of commissioners on the Citizens Redistricting Commission (commission) be open to public scrutiny and the press (see California Constitution, Article XXI, section 2, subdivision (c); California Goverment Code sections 8252, 11120, 11121, and 11125.1; California Code of Regulations, title 2, sections 60836, 60842, and 60846). The Act also requires that the Bureau of State Audits (bureau) select 60 of the most qualified applicants based upon their voter affiliation, their eligibility to serve pursuant to Article XXI of the California Constitution, the absence of any conflicts of interest, their relevant analytical skills, ability to be impartial, appreciation for California’s diverse demographics and geography, and their racial, ethnic, geographic, gender and economic diversity. To determine each applicant’s identity and qualifications to serve on the commission, and to track the demographic information of the applicant pool, this application seeks personal information about applicants that will be provided to the Applicant Review Panel, bureau staff, the public, including members of the press, the Legislature, and the commission.

CONSEQUENCE OF NOT PROVIDING ALL REQUESTED INFORMATION

Failure to provide all of the requested information will result in your disqualification and the removal of your name from the applicant pool. Thus, if you wish to serve on the commission, for each item of information requested, it is mandatory that you submit a response.

PERMISSION TO USE AND RELEASE PERSONAL INFORMATION

By submitting this application, you acknowledge that the application, all documents submitted in support of your application, including a Statement of Economic Interests (FPPC Form 700), if you are asked to submit one, letters of recommendation, materials generated as a result of any bureau or Applicant Review Panel investigation of you, and all comments about and responses to comments about your application are public records. You agree that the bureau shall provide copies of these materials to members of the public and the press, members and staff of the Applicant Review Panel, bureau staff, the Legislature, the commission, and as otherwise compelled by law. You understand that members of the Applicant Review Panel and the public may make public statements about you. You authorize the bureau to use the information submitted by and about you as the bureau deems necessary to select commissioners and replacement commissioners or otherwise comply with its legal duties, and you also authorize the bureau to post all materials related to your application to serve on the commission on its website.

VOLUNTARY WAIVER OF PRIVACY RIGHTS AND BUREAU LIABILITY

By applying to be a commissioner, you are waiving your privacy and other rights under various state and federal laws, including, but not limited to, the Information Practices Act (Cal. Civil Code section 1798 et seq.), and any defamation, invasion of privacy, and negligence claim you may have against the bureau and those acting on its behalf. Accordingly, by waiving your privacy rights, you are agreeing to permit the bureau to release any and all information submitted by or about you, EXCEPT that the bureau will not post on the Internet your date of birth, physical, mailing, and e-mail addresses (excluding the city and county), and telephone numbers, or the addresses and telephone numbers of your immediate family members. At this point in the process, the bureau will not collect, and please do not voluntarily submit to the bureau, your social security number, driver’s license number, financial account numbers, or health information. By submitting your application, you acknowledge and consent to the release of the information you and others are providing related to you, and except as specifically provided above, you are waiving your right to privacy regarding all information relating to you and your application to serve as a commissioner. This waiver authorizes the bureau to make public information submitted by or about you for a period of twelve (12) years from the date of your application, even if you are not selected as a commissioner. You are providing this waiver voluntarily, understanding that the bureau shall not be legally liable as a result of the release of information submitted by or about you, or as the result of comments made about you by others, that the bureau posts on its website or otherwise releases publicly. This includes claims of defamation, invasion of privacy, negligence, and any other statutory or common law claims.

WHO TO CONTACT

You have a right to review personal information the bureau maintains about you and verify its accuracy. Please contact the bureau’s Privacy Officer at (916) 445-0255, 555 Capitol Mall, Sacramento, California, 95814 if you would like to view or obtain information about the location of your records and the categories of persons who use the information in your records.

Affirmation

I affirm, by entering my initials in the box, that the statements contained in this application are true and correct to the best of my knowledge, and that I have read and understand the Privacy Notification and Waiver.

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School Name and Location:
Course of Study/Major:
Diploma, Degree, or Certificate Obtained:
Date Completed, If Completed:
Number of Years Attended:

From:
To:
Employer Name:
Title/Job Classification (Include Range or Level, if applicable):
Total Worked (Years/Months):
Most Recent/Latest Supervisor:
Address:
Phone Number:
Description of Duties Performed:

Date:
Court:
Location:
* Offense (other pertinent information):

From Date:
To Date:
Address:
City, State, Zip Code:
County (or Country if Outside the United States):

Date of Contribution, if known:
Organization:
Location:
Amount:

Name:
Relationship:
Home Address:
Telephone Number:
Current Occupation:
Current Employer:
Within the past 10 years, has the family member engaged in any of the activities listed above that could cause you to have a conflict of interest?: Yes   No
If you answered “Yes” to the last question:
– When did the activity occur?:
– What was the activity?:
Do you have a special relationship with this person based on any of the three factors described above?: Yes   No

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