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MUCR'S OFFICE <br />2 R 2001 <br />OF SAN LEANDRt <br />S <br />If you are interested in serving on a Board or Commission, please complete this brief Interest Form. The form <br />will be sent to the appropriate City Council Member, and a Citv staff member will send you additional, more <br />detailed information on your board or Commission of interest. As openings occur, you will be contacted and may <br />be asked to provide additional information or take part in an interview. <br />Please attach additional sheets if necessary, and mail this form to the Citv Clerk's office, 835 East 14th Street, <br />San Leandro, CA 9457 . <br />NAME: 112—l., <br />HOME ADDRESS: 7,;Z (._ 17 <,,, �� l U,_ .. (i �, p_.,,_ /..,,_� ,.. S7 ._ .. _� _ ai <br />HOME PHONE: �S/a- 4,?3— 7a4d WORK PHONE: fib- X �y- 03 ya <br />I AM INTERESTED IN SERVING ON: <br />❑ BOARD OF ZONING ADJUSTMENTS J LIBRARY -HISTORICAL COMMISSION <br />❑ HUMAN RESOURCES COMMISSION J PERSONNEL RELATIONS BOARD <br />PLANNING COMMISSION :1 RECREATION & PARKS COMMISSION <br />�.D YOUTH ADVISORY COMMISSION <br />EMPLOYMENT OR VOLUNTEER EXPERIENCE: 1 r 1 <br />RELATED EDUCATION OR TRAINING: <br />