Rental Housing Board Application

Title:

What are your Pronouns:

First Name:

Middle Name:

Last Name:

Home Address:

Zip Code:

Primary phone:

Secondary phone:

In which Ward do you live in?

Don't know which Ward you live in? Use our online Ward Lookup Application: www.santa-ana.org/city-council-ward-map

Email:

Board Membership Category

Employer:

Occupation:

Work Address:

City:

Work Zip Code:

Work phone:

Driver's License No:

Date of Birth:

Years Lived/Worked in Santa Ana:

Language(s) Spoken:

Organizations (Professional, Community, Service or other):

Qualifications, Experience, Education:

The following restrictions and requirements for Rental Housing Board members are in the Santa Ana Rent Stabilization and Just Cause Eviction Ordinance: • Section 8-3180(d): Full Disclosure of Holdings. Nominees for the position of Board Member shall submit a verified statement listing all of their interests and dealings in real property, including, but not limited to, ownership, sale, or management of real property during the previous three (3) years. The Board may promulgate additional regulations. • Section 8-3180(e) Conflict of Interest. Board Members shall be subject to the requirements of the California Political Reform Act and other applicable state and local conflict of interest codes. Accordingly, a Board member shall be disqualified from participating in any hearing on an application, petition, or appeal where the Board Member is either the Landlord or a Tenant residing at the subject property, or has any other form of conflict of interest. In order to determine your eligibility, please complete the requested information below under Eligibility and Disclosure of Holdings, listing your interests and dealings in real property, including but not limited to its ownership, sale, or management during the previous three (3) years. If you have owned, sold, or managed real property in the last three years, you do not have to provide any details other than the address of the properties owned, rented out, or managed, or the name of the brokerage business. If appointed to the Rental Housing Board, you may be required to submit a Form 700 - Statement of Economic Interest.

Fill in your name

I, ________________________ (print name), submit this as a verified statement of interest and eligibility in accordance with my application to the Rental Housing Board established in the City of Santa Ana under the Rent Stabilization and Just Cause Eviction Ordinance.

Answer yes or no to the following statements:

1) I have owned, sold, or managed real property in the last three (3) years. If yes, please include a full list of interests and dealings, include addresses of properties owned, sold, or managed during the previous three (3) years in the box below.

If yes, please include a full list of interests and dealings, include addresses of properties owned, sold, or managed during the previous three (3) years in the box below.

2) I am a realtor*

*Note: The term “realtor” includes anyone who is professionally involved in brokering real estate sales, rentals or leases, not just members of the National Association of Realtors.

3) I own or manage rental property**

**Note: The term “rental property” includes both residential and commercial property.

Remarks (attach resume if available):

Attach Resume

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