APPLICATION
For Appointment to Fill Vacancy
SAN LEANDRO CITY COUNCIL, DISTRICT 1
This application will be forwarded to the City
Council for consideration to fill the vacancy in
District 1, term ending December 31, 2024.
Please type or print
Name Last First Middle Initial
Home Address Address City Zip
Primary Phone ( ) Alternate Phone ( ) (optional)
Email
Current Employment Information
Employer
Address
Position Dates of Employment
Responsibilities
Questionnaire
(A separate sheet may be attached)
Please describe your education, training, and/or any special certifications:
For Official Use
Resident of San Leandro Yes ____ No ____
Resident of District 1 ______ Years
Registered Voter Yes ____ No ____
DRAFT
Please explain why you want to be appointed to the City Council:
Please list any previous City of San Leandro Board, Commission, or Committee on which you have served:
Please list any community organizations to which you belong or have belonged:
Please provide any additional information you wish which covers your qualifications, interests, or training related to this appointment:
I have sufficient time to devote to this responsibility and will attend the required meeting(s) if I am appointed. I am also aware that this application is a public document. If appointed, I will file the necessary disclosure documents as required under the Political Reform Act.
Signature Date
Please return your application in person or by mail to:
Office of the City Clerk
City of San Leandro
835 East 14th Street
San Leandro, CA 94577
You may also submit your application by email to: [email protected] Applications will not be accepted after 5:00 p.m. on (Date TBD). Postmarks not accepted.
DRAFT