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a S�Imt�t�- Tf-0111 8 - Cs REQUEST FOR CONSIDERATION FOR APPOINTMENT TO CITY COUNCIL, DISTRICT 1 I, , residing at , San Leandro, California, am a registered voter and resident of City Council, District No. 1 . I hereby request consideration for appointment to Council Member, Council District No. 1 and request a Candidate's Statement Form in order to state my qualifications for consideration. Have you ever been convicted of a violation of any federal or state law? If yes, please give the details. (Do not include traffic citations.) Yes / No Have you, to your knowledge, ever been under federal or state investigation for possible violation of a criminal statute? If yes, please explain. Yes / No Signature: Printed Name: Telephone No.: (daytime) (evening) NOTICE TO APPLICANTS 1. Requests for Consideration of appointment to Council District No. 1 will be accepted in the City Clerk's Office, 835 E. 14th Street, Room 205, from June 25 through July 13, 2001. during normal working hours. 8:30 a.m. to 5:00 p.m. 2. Any person is eligible to hold office as appointed Council Member if such person is a registered voter of the city and a resident of the district from which such person's elected predecessor was nominated, and was a resident of such area and a registered voter of the city at the time of appointment and for a period of thirty days immediately preceding appointment. 3. All Requests for Consideration and Candidate Statements are public records and are available for public review at the close of the filing period. Voter Registration Verification: Residency/District Verification: City Clerk