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Environmental Sustainability
Commission Application
Submit appl
ication to:
Office of the City Clerk
3300 Capitol Avenue, Building A
P.O. Box 5006
Fremont, CA 94537-5006
Or email to: [email protected]
Personal Information:
Mr.
Mrs.
Ms.
Name: ______________________________________________________________________ Last First MI
Home Address:
Street Cit y State Zip
Home Tel
ephone: _ __________ Work Telephone: __ _____________________ E-mail: _ ____________ Fax: ___________________________ Resident of the City of Fremont: ___ years
Commiss
ioners with specific expertise/experience are sought for four of the seats, including:
Student (high school or college)
Business Community
Development/Construction Industry
Environmental Organization
The other
three seats are intended for the public-at-large. All Commissioners must reside in Fremont. Please c
heck one of the above.
Demographic Information:
Ethnicit
y:
□ American Indian or Alaskan Native □ Chinese
□ Black or African American □ White
□ Afghan □ Vietnamese
□ Mexican □ Filipino
□ Indian □ Pakistani
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□ Other Asian origin: ________________ (write-in optional) □ Other African origin: _______________ (write-in optional) □ Other Hispanic, Latino, or Spanish origin: __________ (write-in optional) Gender:
□ Male □ Prefer to self-identify
□ Female □ Prefer not to say
Language(s) Spoken: ____________________
Background Informati
on:
Why do you wish to serve as a member of this Board or Commission? What would you bring by way of perspective or experience to this Board or Commission? Employment/Volunteer Information:
Please list any qualifications you feel would provide positive input to the work of the Board or Commission.
Organization: _______________________________________ Dates: ____________________ Location: ________________________________ Position(s): __________________________ Responsibilities/accomplishments:
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Organization: _______________________________________ Dates: ____________________
Location: ________________________________ Position(s): __________________________
Responsibilities/accomplishments:
Organization: _______________________________________ Dates: ___________________
Location: ________________________________ Position(s): __________________________
Responsibilities/accomplishments:
Organization: _______________________________________ Dates: ____________________
Location: ________________________________ Position(s): __________________________
Responsibilities/accomplishments:
Community Activities you have been involved with (feel free to attach separate pages):
____________________________________________________________________________ Name of Organization Position/Responsibilities/Accomplishments Dates
____________________________________________________________________________ Name of Organization Position/Responsibilities/Accomplishments Dates
____________________________________________________________________________ Name of Organization Position/Responsibilities/Accomplishments Dates
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Special Awards or Recognitions you have received:
Education Information:
____________________________________________________________________________ Educational Institution Degree/Diploma Field Year
____________________________________________________________________________ Educational Institution Degree/Diploma Field Year
Additional Information: (Please provide any other information which you feel would be useful to the City Council in reviewing your application.)
Civic service is a privilege and responsibility of interested, qualified, sincere citizens. The value and importance of wide participation of a large number of citizens cannot be measured. Your interest in serving on a board or commission of the City of Fremont is greatly appreciated.
General Information: Your application is a public document and will be kept on file for one year.
If you would like additional information, please call the City Clerk’s Office at (510) 284-4060.
Please sign and date your application and submit to the Office of the City Clerk.
____________________________ _____________________________ Signature Date