Community Sector Representative Nomination Form

Fresno Economic Opportunities Commission

This signed form and documentation must be submitted by FRIDAY, OCTOBER 6, 2023.

You must also submit a resolution of support for this 2 year term from the agency, organization or group you are representing signed within 60 days of the due date. If the organization is a public entity, submit a letter from an authorized official.

Name*
First Middle Last
Address*
No P.O. Boxes. Must be a physical address.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email Address:*
Number of years as a Fresno County resident:*
Organization representing:*
Organization address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Your Cellular Phone:*
Date of Birth*
MM slash DD slash YYYY
Age:*
Current Work Position / Title / Name of Organization:*
You may also submit a resume if you have one
Resume Upload:*
Only PDF, DOC, and DOCX accepted
Accepted file types: pdf, doc, docx, Max. file size: 50 MB.
Relevant experience including current / past board service:*
How will the organization and you be an asset to Fresno EOC?*
List the reasons for your interest in Fresno EOC Board of Commissioners:*
List the reasons for your organization's interest in Fresno EOC Board of Commissioners:*
Conflict of Interest declaration
Any close relative employed by Fresno EOC?*
- Yes
- No
Name / relationship to person employed by Fresno EOC:*
I have an economic interest in Fresno EOC.*
- Yes
- No
Please explain your economic interest in Fresno EOC.*
Certification
I agree to the following statement.
I certify under penalty of perjury that the above is true and that:
• I am or will be 18 years of age or older by the date of my appointment;
• I am not an employee of Fresno EOC nor a member of the immediate family of an employee of Fresno EOC;
• I have read and understand the Fresno EOC Commissioner Job Description and have the capacity to serve;
• I understand that there is a mandatory training for new commissioners in January and a board retreat in March;
• I am not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any federal department or agency;
• I have not been convicted of or had a civil judgment rendered against me for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction, for violation of federal and state antitrust statutes or for commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;
• I have not been indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state or local) with commission of any of the offenses above; and
• I have not had any public transactions (federal, state or local) terminated for cause or default during the three years prior to the application.
Making a false certification is cause for removal from the Board. If you are unable to certify the above information, do not check the certification box. Instead, please upload an explanation here.
Upload explanation of why you are unable to certify the above.*
Only PDF, DOC, and DOCX accepted
Accepted file types: pdf, doc, docx, Max. file size: 50 MB.
Signature*
Date of Signature*
MM slash DD slash YYYY
You must upload a resolution of support from the agency / organization / group you propose to represent.*
Only PDF, DOC, and DOCX accepted
Accepted file types: pdf, doc, docx, Max. file size: 50 MB.
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You may also submit a signed Community Sector Representitive Nomination Form by mail, email, and hand delivery.

By mail:

Fresno EOC Elections Office
Post Office Box 992
Fresno, CA 93714

By email:

Elections@Fresnoeoc.org
By 11:59 PM on October 6, 2023

Hand delivered:

Fresno EOC
1920 Mariposa Street, Suite 300
Fresno, CA 93721
By 5:00 PM on October 6, 2023

Fresno Economic Opportunities Commission