Office of the City Clerk ꞏ 200 S. Anaheim Blvd., Suite 217, Anaheim, CA 92805 ꞏ (714) 765-5166 Application for Appointment – City Council, District 4 Rev. 12/22 City of Anaheim
APPLICATION FOR APPOINTMENT
CITY COUNCIL, DISTRICT 4
The City of Anaheim is accepting applications to fill a District 4 City Council seat vacancy for a term ending December 2024. Pursuant to Section 501 of the Charter, interested candidates must be a resident and qualified elector of District 4 at the time of and for the thirty (30) days immediately preceding appointment.
DUE DATE: Applications are due to the Office of the City Clerk by XXX, XX XX, 2023 at 5:00 P.M. (Postmarks not acceptable) Submit to: Office of the City Clerk, City of Anaheim, 200 S. Anaheim Blvd., Ste. 217 Anaheim, CA 92805; Email : [email protected] Fax: (714) 765‐4105 Note: This application is considered public information and will be released to the public, including being posted to the City’s website.
Years lived in District 4, City of Anaheim: Years lived/worked in City of Anaheim:
Professional and Educational background (may submit Resume):
Applicant Information
Prefix: Name:
Address: City: State: Zip Code:
E‐Mail: Phone Number:
Home Work Cell
Alternate Phone Number:
Home Work Cell
OCROV – Verified Qualified Elector
Office Use Only
Office of the City Clerk ꞏ 200 S. Anaheim Blvd., Suite 217, Anaheim, CA 92805 ꞏ (714) 765-5166 Application for Appointment – City Council, District 4 Rev. 12/22
List any City of Anaheim, County, and or other Board/Commissions and/or organizations on which you have served (professional, technical, community, service):
Reasons why you are interested in serving. State your interest in the position, qualifications, skills, or experience that can best serve the residents of District 4 and the City of Anaheim (separate attachment may be included):
Name:
Office of the City Clerk ꞏ 200 S. Anaheim Blvd., Suite 217, Anaheim, CA 92805 ꞏ (714) 765-5166 Application for Appointment – City Council, District 4 Rev. 12/22
What do you see as the top issues facing District 4 and the City of Anaheim? (Separate attachment may be included):
What are your priorities for District 4 and the City of Anaheim? (Separate attachment may be included):
VERIFICATION
Pursuant to Section 501 of the Charter, I am and have been a resident and qualified elector of District 4 at the time of and for the thirty (30) days immediately preceding possible appointment to office. I declare under penalty of perjury under the laws of the State of California that the information contained herein is true and accurate to the best of my knowledge.
I acknowledge that the City has the right to verify the truth and accuracy of all information submitted and that this is a public document.
Signature: Date:
Name: