CIT Y 01"
HAYWARD
HEAR T OF TH E BAY
APPLICATION
For Appointment to Fill a Two- Year Term Vacancy on the
HAYWARD CITY COUNCIL
For Official Use
This application will be forwarded to the City
Council for consideration to fill the vacancy for
the term ending June 2016. Resident of Incorporated Hayward Yes _No_ Please type or print
Registered Voter Yes No
Name D Mr. D Ms. _ _____________________ _
Last First Middle Initial
Home Address ------------------------------
Address City Zip
Home Phone Cell Phone
Work/Alternate Phone Email
Employer:
Address:
Position:
Current Employment Information
Dates of Employment: -------------
Responsibilities: -----------------------------
(Upon submission to the City of Hayward this document becomes a public record)
ATTACHMENT II
CIT Y OF
HAYWARD
HEAR T OF TH E 6A'1
Questionnaire
(A separate sheet may be attached)
Describe your education, training, and/or any special certifications relevant to serving on the City Council:
Explain why you want to be appointed to the City Council and what your goals for the two years will be if you are selected:
List any previous City of Hayward Board, Commission, or Committee on which you have served; and any other relevant Hayward community service in which you have been involved or are currently involved:
(Upon submission to the City of Hayward this document becomes a public record) 2
ATTACHMENT II
CIT Y OF
HAYWARD
HEAR T OF TH E 6A'1
Briefly, please provide information on any additional relevant experience you believe supports your qualifications for this appointment:
I have sufficient time to devote to this responsibility and will attend the required meetings if I am appointed. I am also aware that this application is a public document. If appointed, I will file the necessary disclosure documents as required under the Political Reform Act.
Signature Date
Please return your application by noon on Wednesday,July 16, 2014 to:
Miriam Lens, City Clerk
City of Hayward
777 B Street, 4th Floor, Hayward, CA 94541
Miriam.lens@hayward- ca.gov
(5 l 0) 583- 4401
No application will be accepted after the deadline.
(Upon submission to the City of Hayward this document becomes a public record) 3
ATTACHMENT II