Supplemental Application for Citizens Redistricting Commission | California Citizens Redistricting Commission

EXAMPLE APPLICATION – DO NOT ATTEMPT TO SUBMIT

Thank you for completing the initial application for the Citizens Redistricting Commission. You must provide an answer to all questions that apply to you. You will be prompted to answer any required questions that have not been answered before you can submit your application. Your unique identification number is 999999.

At any point, you can save your application using the Save Application button. After the application has been saved, you can come back to the site to complete the application later, using your password and e-mail address.

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.

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.

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.

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.

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

You may add additional educational history using the button above.

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:
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*:

* 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.

You may add additional employment history using the button above.

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.

Criminal History

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

Yes
No

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).

You may add additional criminal history using the button above.

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?

Yes
No

If yes, for each of the elections in which you voted, list the date of the election, the county in which you voted, and the name and address that you used.

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

You may add additional former residences using the button above.

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:
Organization:
Location:
Amount:

You may add additional financial contributions using the button above.

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?

Yes
No

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:
Relationship:
Home Address:
Telephone Number:
Current Occupation:
Current Employer:
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): Resided with that person for a period or periods totaling 30 days or more – Examples. Shared with that person ownership of any real or personal property having a total value of $1,000 or more – Examples. 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

You may add additional family members using the button above.

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.

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 999999. 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.

INITIALS:

Submit Application

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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