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Board and Commission Application
Board or Commission you wish to serve on: _____________________________
(Planning Commission applicants: Please attach supplemental questionnaire)
Submit application to:
Office of the City Clerk
3300 Capitol Avenue, Building A
P.O. Box 5006
Fremont, CA 94537-5006
Personal Information:
Mr.
Mrs.
Ms.
Name: ______________________________________________________________________ Last First MI
Home Address: _______________________________________________________________ Street City State Zip
Home Telephone: ________________________ Work Telephone: _______________________
E-mail: ______________________________________ Fax:___________________________
Resident of the City of Fremont: ____________ years
Demographic Information:
Ethnicity:
□ American Indian or Alaskan Native □ Chinese
□ Black or African American □ White
□ Afghan □ Vietnamese
□ Mexican □ Filipino
□ Indian □ Pakistani
□ Other Asian origin: ________________ (write-in optional) □ Other African origin: _______________ (write-in optional) □ Other Hispanic, Latino, or Spanish origin: __________ (write-in optional)
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Gender:
□ Male □ Prefer to self-identify
□ Female □ Prefer not to say
Language(s) Spoken: _____________________
Background Information:
Why do you wish to serve as a member of this Board or Commission: ____________________
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What would you bring by way of perspective or experience to this Board or Commission: _____
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Employment/Volunteer Information:
Please list any qualifications you feel would provide positive input to the work of the commission.
Organization: _______________________________________ Dates: ____________________
Location: ________________________________ Position(s): __________________________
Responsibilities/accomplishments: ________________________________________________
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Organization: _______________________________________ Dates: ____________________
Location: ________________________________ Position(s): __________________________ -3-
Responsibilities/accomplishments: ________________________________________________
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Organization: _______________________________________ Dates: ____________________
Location: ________________________________ Position(s): __________________________
Responsibilities/accomplishments: ________________________________________________
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Organization: _______________________________________ Dates: ____________________
Location: ________________________________ Position(s): __________________________
Responsibilities/accomplishments: ________________________________________________
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Community Activities that you have been involved with (feel free to attach separate pages):
____________________________________________________________________________ Name of Organization Position/Responsibilities/Accomplishments Dates
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____________________________________________________________________________ Name of Organization Position/Responsibilities/Accomplishments Dates
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Special awards or recognitions you have received: ________________________________
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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.)
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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.
Thank you.
__________________________________________ _____________________________ Signature Date