City of
San Bernardino
RECEIVED
BOARDS, COMMISSIONS, & CITIZEN ADVISORY
FOUNDED IN 1940 Co Only
COMMITTEES CITY COUNCIL OFFICE
BOARD(8), COMMISSIONS), AND/OR CHIZEN ADVISORY COMMITTERS) APPLYNG FO Bemardino Planning Commission
2. 4.
LAST NAME FIRST NAME M.I.
Ali Mohammed A
HOME ADDRESS ZIP PHONE
(HOME)
(MOBILE)
EMPLOYER JOB TITLE EMAIL ADDRESS
BUSINESS ADDRESS ZP BUSINESS PHONE
DATE OF BIRTH
Length of residence in the City of Are you a registered voter of the City Which ward do you reside in? San Bemardino of San Bemardino?
_Years ) Yes •'
Months NO 0'D'
Why you want to serve on a city board or commission:
Having experienced personal and business success in the city of San Bernardino; I believe it is time, for me, to Board(s), Commission(s), & Citizen Advisory Connittee(s) App. Page 1 of 3 Updated: August 29, 2018 What do you consider to be three (3) major assets that would qualify you for selection to this board, commission, or citizen advisory committee:
1. I have and continue to dervelop a broard business aquity and life experience.
2. I am a hard worker and I never quit until the job is done!
3. I have a tremendous amout of integrity based on great Family Values and honesty that I learned in my Home.
Experience or special knowledge pertaining to area(s) of interest:
Educational background:
I completed my High School Edudation.
Occupational experience:
I have over 30 years experience owning, managing and training teams of employees to perform thier very best! Professional or technical organization memberships:
Tam a faithful and committed member of my local Mosque! Board(s), Commission(s), & Citizen Advisory Conunittee(s) App. Page 2 of 3 Updated: August 29, 2018 Civic or community experience, memberships, or previous public service appointments:
death or lass of a loved-onel
OPTIONAL
How would you classify yourself? (Optional)
•American Indian/Alaskan Native African American/Black Asian Hispanic/ Latino -Native Hawaiian/Pacific Islander White Two or more of the above categories
What is your gender? (Optional)
• Female •other/Prefer to self-describe
O Male
Are you a person with a disability? (Optional)
) Yes ONO
Applications are screened on the basis of information submitted and may be subject to a Livescan as part of the application process.
The information provided is factual to the best of my knowledge. I understand that I may be required to complete a Statement of Economic Interests Form as required by law, and that I will abide by all the codes, ordinances, and regulations of the City of San Bernardino and the State of California.
5/19/26
SIGNATURE DATE
Return to: The City of San Bernardino Council Office
lectronically: [email protected]
y Mail: 290 North D Street, San Bernardino, CA 9240
In Person: 290 North D Street, 1st Floor - City Information Center, San Bernardino, CA 92401
*Attach a resume and/or additional information which you feel will assist the Mayor and City Council in their selection.
Board(s), Commission(s), & Citizen Advisory Conunitteds) App. Page 3 of 3 Updated: August 29, 2018