OR MORENO
VALLEY MOREND VALLEY CLERK
City of Moreno Valley '25 JUL 10 Px2:30
City Council Advisory
DECEMBER 3, LEA Boards and Commissions
Stamp Defend Time Lecived
Membership Application Form
Name: Zainal Allamas i
Home Address: Morens valley CIA 92557
City Council District:
How long have you resided in Moreno Valley? 1Z years
ELIGIBILITY
Are you at least 18 years of age? Yes I No D
Are you a registered voter of the City of Moreno Valley? Yes & No O Do you authorize the City to process a criminal background check? Yes No O
EMPLOYMENT
VOLUNTEER SERVICE
Name of Organization: MUUSD
Purpose: Food Destip.
Title:
Length of Time: #/ Xeam.
1 Revised June 10, 2025
BOARD OR COMMISSION INFORMATION
Board or Commission applying for*:
151 Choice If a Cic Salty
2nd Choice
3rd Choice
*If applying for the Accessibility Appeals Board, please indicate which position you are applying for:
• Physically Challenged Member • Member Experienced in Construction • Public Member
*If applying for the Utilities Commission, please indicate which position you are applying for:
• Public Member Customer of Moreno Valley Utility
• Business Customer of Moreno Valley Utility
Do you currently serve on a City Board or Commission? Yes A No L A. If yes, please list: Iratic Safte
Have you previously served on a City Board or Commission? Yes ENo D A. If yes, please list:_ Irapic sap
Do you have any immediate family members serving on the city council or employed with the City of Moreno Valley? Yes • NoDE-
Can you attend evening meetings (6:00 pm - 9:00 pm) at least once or twice a month? Yest No O Are there days you cannot attend evening meetings? Yes • No/K A. If yes, please list:
List any education, training, or special skills you have which may be relevant or of particular benefit to this Board and/or Commission:
In allyach in Postion I like Plug
The Comes and helpart
2 Revised June 10, 2025
ACKNOWLEDGEMENT
I acknowledge that I was provided with the attached copy of Legislative Policy #1.10 (City Council Advisory Boards and Commissions) and offered an opportunity to ask questions regarding any of its provisions prior to
CERTIFICATION
I certify that all statements in this application are true and complete to the best of my knowledge. I understand that any false statements of material fact will subject me to disqualification or dismissal if appointed. 07/10/ 2025
Print Name/Signature Date
All Applications shall be submitted to the City Clerk's office at Moreno Valley City Hall - located at 14177 Frederick St., Moreno Valley, CA 92553 - during regular office hours (7:30 a.m. to 5:30 p.m., Monday through Thursday, and 7:30 a.m. to 4:30 p.m. Friday). Alternatively, applications may be submitted by mail or electronically via the City Clerk's email [email protected].
Background Check Authorization
As part of the application process for service on a City Advisory Board, a criminal background check will be conducted through the California Department of Justice. Please be advised that you will not be provided with a copy of the criminal background information received from the Department of Justice unless you are deemed ineligible due to a disqualifying criminal conviction.
Attachment: Legislative Policy #1.10 - City Council Advisory Boards and Commissions 3 Revised June 10, 2025