HomeMy WebLinkAboutApplicationCITY OF NATIONAL CITY
APPLICATION FOR APPOINTMENT
TO CITY BOARDS, COMMISSIONS, AND COMMITTEES
Civil Service Commission Planning Commission
Community & Police Relations Commission* (CPRC) _ Public Art Committee*
✓ Library Board of Trustees _ Traffic Safety Committee
Parks, Recreation & Senior Citizens Advisory Board
Note: Applicants must be residents of the City of National City except for those marked by an *
Applicants for the Community and Police Relations Commission must pass a criminal
background check prior to appointment.
Name: Mar.; c Pck,'r-; Dr.
Home Address: (D33 E 164 6+. o . e�� n-�,oNvTel. No.: Le 19 q'-1y _a-) 19
Business Affiliation: Lc .s Title: C
Business Address: C33 I✓ 1s} S&. f14o--aQ C\ Tel. No.:
Length of Residence in National City: 30 r.rs San Diego County: 3°y, California: 3o�cs
Educational Background: C Ede .. / ( off r-J c +k_ S ys , ej,cr. \-
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Occupational Experience: UiVi �. - LL.--e,--s: 'C n.,s�-rv�t-o r / \gyp; Ct-s ��. c�.1
R O.s tog a. �,c . C,�� \oJr J-i1 `tJ'f� �i?P Uskcrs 1r0� Cl�b✓4;",- oc
Professional or Technical Organizatitni Memberships: T)k3, }Lci,Po,_ , O- T N E
Civic or Community Experience, Membership, or Previous Public Service Appointments:
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Experience or Special Knowledge Pertaining to Area of Interest:
r, l � bran �_ c-tom o f o e � R. Y�1 cli'c,.."�"Urq c,
Have you ever been convicted -
of a felony crime? No: Yes: misdemeanor crime? No: Yes:
J
If any convictions were expunged disclosure is not required. Convictions are not necessarily
disqualifying.
Please feel free to provide an explanation or information regarding yes answers to the above two
questions.
Date: Do{ , / 13 Signature:
Please feel free to provide additional information or letters o e ent.
Please retum completed form to:
Office of the City Clerk
1243 National City Blvd, National City, CA 91950
Thank you for your interest in serving the City of National City.
* Residency requirements may not apply
This documents is filed as a public document Revised: March 2012