1. 2.
Hayward City Council Vacancy
Application to fill a two-year term vacancy on the Hayward City Council. This application will be forwarded to the City Council for consideration to fill the vacancy for the term ending December 2024.
Submit a physical copy by 9 a.m. on Tuesday, Jan. 3, 2023 to:
Miriam Lens, City Clerk
City of Hayward
777 B St. 4th Floor
Hayward, CA 94541
(510)583-4401
No application (print or digital) will be accepted after the deadline. * Required
First Name *
Last Name *
3. Mark only one oval.
Other:
Female
Male
Nonbinary or third gender
Prefer to self-describe
Prefer not to say
4. 5.
6. Mark only one oval.
Yes
No
Gender*
Mark only one
Home Address (Street Address, City, State, Zip Code)*
ex: 777 B St. Hayward, CA, 94541
Phone Number*
ex: 510-583-4400
Are you a resident of incorporated Hayward?*
7. Mark only one oval.
Yes
No
8. City Council History
9. Mark only one oval.
Yes
No
10. Example: January 7, 2019
Current Employment Information
11. Are you a registered voter?*
Please list any languages you speak, read, and/or write besides English and your proficiency in each language.
Have you ever served on the Hayward City Council?*
If yes, when?
Current Employer*
12. 13.
14. 15.
Questionnaire
16. Current Employer Address*
Position*
Dates of Employment*
Responsibilities*
Describe your education, training, and/or any special certifications relevant to serving on the City Council:
*
One (1) separate sheet may be attached
17. 18.
19. 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:
*
One (1) separate sheet may be attached
List any previous City of Hayward Commission, Committee, or Task Force on which you have served; and any other relevant Hayward community service in which you have been involved or are currently involved:
*
One (1) separate sheet may be attached
Briefly, please provide information on any additional relevant experience you believe supports your qualifications for this appointment:
*
One (1) separate sheet may be attached
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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 required under the Political Reform Act.
*
Signature:
I certify under penalty of perjury that the foregoing is true and correct * Signature:
Forms
Signature