Clerk's
Com m iss ion / Com m ittee I Board
lication for Appointment or Reappointment ugrq -?,\ I
(This is a Public Record Subject to Disclosure)
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Name
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Residence Street Address &4O W EER /O/ City SON
Mailing Address &f O W flt/
Phone (home)- (cell) eo? 20& e6L' (work
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Emair Addr "* PonEG.u/ @ PrLMoo , Co nlength of time at residenc" lpt Employer S 9l^f
rience or Special K e rtaining to Area of lnterest
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ployment Experience Nlrr-t €.om
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o anization, Com n or Public Service ce ,J t I
Education (high school, college, trade school or training) Note reisnos c educational m
Do you have any financial or professional interest or association related to this position? Ilf yes, please explain Yes No
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When are you available to attend this commission/committee/board regular and/or special meetings? inil ifJr
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File this application with The ity Clerk of the City
P.O. Box 667
L Plaza,2nd Floor.
Patterson, CA 95363
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0 ';;"?;#nontainifAtid$#,l,ffiitr,rormationlB.r,ie$friilrl*iu u. r,#uir the city councir in '.,?mf,,ng,qvour anRtisa{iTrgtgfu, fn sr3h.-::, +; ,:i::.i A p p r! cATr o N cE RTr Ft cATro N : PLEASE n6D'afto$ffEF0 RE'S rfiu r rv e.
I certify tt.t ttle'it5yf',ents made by me in this appticatiqfl,aiJ.trq6, Ahtttl, ** .dir&Stolr${e51.os ,, knowledge and belief, I understand that statements made are subject to verification and that al1;,r rngepresentation, fraud, or omission of material facts may result in denial of appointment/reappointment. f ^r' i ; - I hereby authorize representatives of the City of patterson to c0 and in
this appl n a
appointment/reappointment decisions only
I understand and hereby ccept that if the City Council of the City of patterson appoints/rea ppoints me to a City of a 'PetlSRon ittbs/.DbrL{ir-'vfiil 3ubte}ltqthe ..FF.lt
Practices
City Ordi am
fingerprint (background) test.
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(The City Clerk's office will keep your application on file for one (1) year from the date stamped received) ta
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