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a�sAN`Fg APPLICATION <br />FOR APPOINTMENT TO FILL VACANCY <br />OHIO*, SAN LEANDRO CITY COUNCIL, DISTRICT 4 <br />This application will be forwarded to the City For Official Use <br />Council for consideration to fill the vacancy in <br />District 4, for the term ending December 31 Resident of San Leandro Yes No <br />2012 Resident of District 4 Years <br />Registered Voter Yes No <br />Please type or print <br />Name ❑ Mr. ❑ Ms <br />Last <br />Home Address <br />Address <br />Home Phone ( <br />Work /Alternate Phone � ) <br />City <br />Cell Phone � ) <br />Email <br />Current Employment Information <br />Employer <br />Address <br />Position <br />Responsibilities <br />First <br />Middle Initial <br />Dates of Employment <br />Questionnaire <br />(A separate sheet may be attached) <br />Please describe your education, training, and /or any special certifications: <br />Zip <br />(optional) <br />(Upon submission to the City of San Leandro, this document becomes a public record.) <br />