APPLICATION FOR APPOINTMENT
TO THE CITY COUNCIL
100 Gregory Lane, Pleasant Hill, CA 94523-3323 – (925) 671-5270 www.pleasanthillca.org
Last Name: First Name:
Residence Address:
Cell Phone: Daytime Phone:
Email Address:
In what way(s) are you currently active in the community? Why do you want to be on the City Council?
What experience would you bring to the Council that you feel would be of most benefit to the City and its residents, businesses, and visitors?
I swear (or affirm) that I am a resident of County, and I am registered to vote at the address shown on this application.
Date: Signature:
Return this form by January 27, 2023 to:
City of PleasantHill City Manager’s Office
Attn: Juanita Davalos
100 Gregory Lane
Pleasant Hill, CA 94523-3323
Email: [email protected]
Other than telephone numbers, the information in this form is subject to public disclosure upon request under the California Public Record Act.