City of San Rafael Employee DEIB Committee Application

The City of San Rafael is committed to creating a Diversity, Equity, Inclusion and Belonging (DEIB) Committee with diverse perspectives, opinions and ideas, and is seeking to identify a wide array of individuals to serve as inaugural committee members.  

Applications are due by June 9, 2023. 

The information below is optional to provide, and no question is required to be answered in order to be considered for the committee. You may skip any question you do not want to answer.

Personally identifiable information that is provided will be held confidentially and only be viewed by Human Resources.

If you have any questions please contact Alissa Curtin / alissa.curtin@cityofsanrafael.org.


In a few sentences, please respond to the following questions:
1.Why do you want to join the DEIB committee?
2.What skills and/or perspectives will you bring to the committee?
3.What kind of DEIB initiatives do you think are important for local government to work on?
4.What support (if any) would you need to balance your current work with your participation on this committee, if selected?
5.Your Name
6.Pronoun(s)  (Optional to share)
7.Your Department
8.What is your age group?
9.What gender do you identify as?
10.Do you identify as a member of the LGBTQ+ community
11.Which of the following racial or ethical groups do you identify with?*
12.Do you speak any language(s) in addition to English? If so, please specify. (Both questions optional).
13.Do you live in Marin County?
14.How long have you worked for the City?
15.What is your parental/family status and/or do you have adult dependents? (Check all that apply)
16.Do you identify as a person with a disability or a person who is neurodiverse?
*For purposes of this application, definitions of racial and ethnic groups are defined as follows:

White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American - A person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African American."

Latina, Latino, Latinx or Hispanic - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term, "Spanish origin," can be used in addition to "Hispanic or Latino."

Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

American Indian or Alaskan Native -  A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.