Application for Department of Consumer Affairs Director Appointment to an Advisory Council or Committee The Department of Consumer Affairs (DCA) protects and serves California consumers while ensuring a competent and fair marketplace. To support this effort, DCA fosters relationships with consumer and public interest groups, the business and professional community, law enforcement, and other government agencies. The DCA has 38 regulatory boards, bureaus, committees, commissions, and programs that protect public health and safety through licensing and oversight of various professions. Some DCA bureaus have advisory councils and committees that advise their respective programs on policies and help guide licensing, enforcement, public education, and consumer protection activities. For some of these advisory councils and committees, the DCA director is authorized to appoint members. Application instructions Please complete this application in full and submit it, along with a current résumé. You will have the option to upload your résumé after submitting this form. Your submitted résumé MUST include: full work history, educational history (including college/graduate school, graduation date, degree awarded, and major), and all professional certificates/licenses you currently hold or have previously held. Submitted applications without a complete résumé will not be considered. The submission of this form does not commit you to being a council/committee member or guarantee that you will be selected to a council/committee. Advisory Committee/Council for Which You Are Applying Choose Bureau for Private Postsecondary Education Advisory Committee Bureau of Security and Investigative Services Advisory Committee Bureau of Household Goods and Services Advisory Council California Massage Therapy Council Bureau for Private Postsecondary Education Advisory Committee I am seeking an appointment as: CLICK HERE TO CHOOSE AN OPTION BELOW Consumer advocate Current or past student of an institution approved by the Bureau for Private Postsecondary Education A representative of an institution approved by the Bureau for Private Postsecondary Education Employer of students * Please explain your qualifications for your selection. Bureau of Security and Investigative Services Advisory Committee I am seeking an appointment as: CLICK HERE TO CHOOSE AN OPTION BELOW Public representative Industry representative * Please explain your qualifications for your selection. If industry representative, check all that apply and include your license number. Industry License number Alarm company Collateral recovery Locksmith company Private investigator Private patrol operator Industry License number Proprietary security Security guard Baton/firearm training Facility/instructor Bureau of Household Goods and Services Advisory Council I am seeking an appointment as: CLICK HERE TO CHOOSE AN OPTION BELOW Public representative Industry representative * Please explain your qualifications for your selection. If industry representative, check all that apply. Industry role Manufacturer Service contract seller Retailer Independent service repair professional Service contract administrator Importer Custom upholsterer Supply dealer Movers and storage Product market Electronic Appliance Computer Bedding Upholstered furniture Thermal insulation Movers and storage California Massage Therapy Council I am seeking an appointment as: CLICK HERE TO CHOOSE AN OPTION BELOW Public representative Applicant Information * Denotes required field * First Name Middle Name * Last Name * Mailing Address Line 1 Mailing Address Line 2 * Mailing Address City *Mailing Address State * Mailing Address Zip * Mobile Phone *Home Phone * Email Current Business or Professional Address *Professional Title * Business/firm/office * Business Address Line 1 Business Address Line 2 * Business Address City *Business Address State * Business Address Zip *Business Phone * Business email Current Professional Work *Professional Title * Business/firm/office Dates of employment: *From * To * Business Address Line 1 Business Address Line 2 * Business Address City *Business Address State * Business Address Zip * Business Phone * Summary of job duties: Organizations and Society Memberships None #1 *Name * Title * Active Member? YES NO If no, please provide date of involvement: From To * Details: Add more Remove Military Service Not Applicable *Branch *Rank *State of Service Service dates: *From *To Additional Information *Have you ever served on a board, commission, committee, council for the Department of Consumer Affairs OR other California state agency? YES NO If yes, please provide the name of the agency/agencies and the time period you served in this capacity: *Have you ever been a registered lobbyist or have you lobbied at any level of government? YES NO If yes, please explain and include the time period you served in this capacity: *Have you ever been formally disciplined, cited for a breach of ethics or unprofessional conduct or been the subject of a complaint to any court, administrative agency, professional association, disciplinary committee, or other professional group? YES NO If yes, please explain: *Have you ever been involved in civil litigation or administrative or legislative proceedings of any kind, either as plaintiff, defendant, respondent, witness, or party of interest? YES NO If yes, please explain: *Have you ever been convicted of a violation of any federal, state, county, or municipal law, regulation, or ordinance (do not include traffic violations for which a fine of $500 or less was imposed)? YES NO If yes, please explain: *Are you currently under federal, state, or local investigation for possible violation of a criminal law or ordinance? YES NO If yes, please explain: *Have you ever run for political office, served on a political committee, or been identified publicly with a particular political organization, candidate, or issue? YES NO If yes, please explain: *Do you know anyone who might take any steps to oppose your appointment? YES NO If yes, please explain: *Is there anything in your background that, if made known to the general public through your appointment, would cause an embarrassment to you, the Department of Consumer Affairs, or the administration? YES NO If yes, please explain: *Do you own real property, personal property, financial holdings, or receive income from any source related to the position that you are applying for, which may present a potential conflict of interest or appearance of conflict of interest? YES NO If yes, please explain: *Please provide a brief statement on why you would like to serve on the council/committee for which you are applying. Attach additional pages, if necessary.
