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OFFICIAL APPLICATION FORM
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2022 SEP -7 PM I; 05 city aerk °,r Deputy city clerk
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CITY OF PASADENA
APPLICATION FOR APPOINTMENT TO THE CITY COUNCIL, DISTRICT 3 The information contained on this form will be iised by the Pasadena City Council to fill a vacancy for the District 3 seat dne to the passing of the Honorable Cozmcilmember John J. Kennedy. All applicants must be a resident living in Coimcil District 3, of voting age, and registered to vote in Council District 3 at the time the application is issued by the City Clerk. Applicants are invited to attach additional pages, a copy ofyoiir resume, or submit supplemental information which yon feel may assist the City Cozmcil in its evaluation of your application.
Applicant Name: U/» CA^O(S> W< ^§mi^4:V\
Home Address:
Employer: ^^-^,^ <?H^ri<n<^ ^W<k
Work Address: ^ ^ .^jto.-^t ^//^~^
Community Service - List boards, commissions, committees, and organizations on which you are currently serving or have served, offices held, and in w^t city.
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Home Phone: i
Work Phone:
E-mail: p'^W^pPbd^iX'cin -.0^
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j^b^f- 'Vf^ ^^•.^.^^ <^ .{<^$aG/er\^ Cl<i^/iployment - Title and duties, current and past. ~~ ^^J ~^v.^^^ ^w^c Wa' ^ n,Q^^^ rt;^cl^ c^^ ^^^.^')
Education - Include professional or vocational licenses or certificates. '3^ A fn^ti~ t-11^. &:A<z>(' 6(3G^_<j^
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1 Meeting of: 09/29/2022 i
Agenda'Item No. 3
Application for Appointment - continued
Personal - Answer "yes " or "no " to the following qiiestions.
1. Have you ever worked for the City of Pasadena? (If yes, please list dates/department) YES NO I
2. Are you related to any employee or appointee of" the City of Pasadena? (If yes, please indicate name and relationship)
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(YES, NO
3. Are you aware that tinancial disclosure will be required to serve? (e.g. sources of income, loans and f^ifls, investinents, interests in real property) 77-:*-,.
(YES "\ NO
4. Rules of law and ethics prohibit members fromparticipating in and voting on matters YES in which they may have a direct or indirect financial interest. Are you aware of any potential conflicts of interest which may develop from your occupation or financial holdings in relation to your responsibilities as a member of the City Council, to which you seek appointment? (If yes, please indicate any potential conflicts) (NO
5. Have there been or are there now, any personal or business circumstances which might YES reflect adversely on the propriety of your serving as a member of the City Council to which you might be appointed?
.NO:
6. Are you aware of the time commitment necessary to fulfill the obligations of the City Council, District 3 seat, to which you seek appointment? NO
7. Please state how long have you been a resident of the City of Pasadena? k~s—^ years Please state how long have you been a resident of City Council District 3? ^ f years months
months
Application for Appointment - continued
2 8. What specifically in your background, training, education, or interests qualities you as an appointee ^ th^ ^^L ^ ^<^^fc? ^^^^ <^^<.^^^--^^^ ^^
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9. What do you see as the objectives and goals of the City Council? ^'\A»^,o C(:?j^Aa^7 f-^. i^ ^
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Application for Appointment - continued
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