HomeMy WebLinkAboutAttachmentsOFFICE OF THE CITY CLERK
1243 National City Blvd.
National City, CA 91950
Michael R. Dalla, CMC — City Clerk
619-336-4228 phone • 619-336-4229 fax
October 10, 2011
TO: Honorable Mayor and City Council
FROM: Michael Dalla, City Clerk
SUBJECT: Status Report - Boards and Commissions
As of the date of this memo, there is currently one (1) new applicant to be
interviewed for the Civil Service Commission.
Notice of Vacancies and Expired terms have been advertised in the newspaper
and posted on public notice boards. If you are aware of any other interested
applicants, please encourage them to apply by 6 p.m. on Monday, October 17,
2011 and to be present at the City Council meeting on October 18, 2011.
Application forms are available from our office and are also available on the
City's web site at: www.nationalcityca.gov
Attached you will find a summary of the status of Boards & Commissions needing
your consideration.
Appointing Authority
Members:
Terms Expire:
Meetings are held:
PUBLIC ART COMMITTEE
Mayor with approval of City Council
5
September 30th
Quarterly
Current Status: There has been one expired term on the Art Committee since
June 2010. Seven applicants, including two incumbent members, are eligible for
appointment.
Eligible Applicants Status
Frank Bueno
Christin Chacon
Wayne English
Darryl Gorham
Pearl Quinones
William Ramsey
Vener Yambao
Expired term
Expired term
Interviewed and eligible
Interviewed and eligible
Interviewed and eligible
Interviewed and eligible
Interviewed and eligible
a
Appointing Authority
Members:
Terms Expire:
Meets:
LIBRARY BOARD OF TRUSTEES
Mayor with approval of City Council
5
September 30th
Monthly
Current Status: There is one (1) current vacancy on the Board due to a
resignation and two (2) terms expired on September 30, 2011. Both incumbents
have requested reappointment and there are two applicants eligible for
appointment.
Applicants Status
Arlene Castillo
Deborah Hernandez
Gloria Bird
Shane Uriate
Expired term - First appointed on 06-03-2008
Expired term - First appointed on 11-03-2009
Interviewed and eligible
Interviewed and eligible
3
CIVIL SERVICE COMMISSION
Appointing Authority City Council
Members: 5
Terms expire: September 30th
Meets: 6 times per year
Current Status: There is one (1) current vacancy on the Commission due to a
resignation and one (1) term on the Commission expired on September 30, 2011.
There is one current applicant to be interviewed.
Applicants Status
Deborah Canedo Needs to be interviewed
Jerry Cano Expired term — First appointed on 04-01-2009
PARKS, RECREATION AND SENIOR CITIZENS ADVISORY BOARD
Appointing Authority
Members:
Terms Expire:
Meets:
Mayor with approval of City Council
7
September 30th
Every two months
Current Status: Four (4) terms on the PRSCAB expired on September 30,
2011. All incumbents have requested reappointment. There is one (1) new
application on file.
Applicants Status
Roberto Andrade
Yvonne Cordoba
James Grier
Howard Schwitkis
Richard English
Expired term — First appointed on 05-19-2009
Expired term — First appointed on 09-21-2004
Expired term — First appointed on 07-14-1987
Expired term — First appointed on 04-19-1991
Interviewed and eligible
5
APPLICATION SUMMARY
ART / CIVIL SERVICE / LIBRARY / PARKS RECREATION SENIOR CITIZEN ADVISORY BOARD
Parks Recreation
& Senior Citizen Art Library Civil Service
Advisory Board
Request
Applicants Interviewed Re -Appoint
Vacancies
Exp term
0 0 1 1
4" 1 2" 1"
Deborah Canedo
N
1
Gloria Bird
Y
1
Shane Uriarte
Y
1
Wayne English
Y
x
Darryl Gorham
Y
x
Frank Bueno
Y
Yes
1
Christina Chacon
Y
Yes
1
William Ramsey
Y
1
Vener Yambao
Y
1
Pearl Quinones
Y
x
Richard Wingfield
Y
x
Roberto Andrade
Yes
1
Yvonne Cordoba
Yes
1
James Grier
Yes
1
Howard Schwitkis
Yes
1
Arlene Castillo
Yes
1
Deborah Hernandez
Yes
1
Jerry Cano
Yes
1
2 = First Choice
x = Willing to serve
" = On Sep 30th
6)
CITY OF NATIONAL CITY
APPLICATION FOR APPOINTMENT
TO CITY BOARDS, COMMISSIONS, AND COMMITTEES
)(Civil Service Commission
Community & Police Relations Commission*
Library Board of Trustees
Parks, Recreation & Senior Citizens Advisory Board
Planning Commission
Public Art Committee*
Traffic Safety Committee
Sweetwater Authority
Note: Applicants must be residents of the City of National City except for those marked by an *
Name: J Av.e - I'i e'-- z'o
Home Address: f231 P.-kr/eh/a Tel. No.: 14-7 Y = /F�2,47
Business Affiliation: Title:
Business Address: Tel. No.:
Length of Residence in National City: 7OilE-S San Diego County: 72- I'..0 California: 72- y/ZS
Educational Background: 4-0 P 12—e / 14/9 C ,9-7! Ar S Cr4-Cs5r
2�4 L ie nA
Occupational Experience: 449 Urs. i'eack;i1 ex ert€ t Vo/un*.ea Wolf' CIA yaw EL c-k.
%tAE OA!Ala �,ti'si l�is�.n r 0 2 -, g ' r'z c rtv Lg 1,4G' Std.- oty
S A-19 d r rto !2-14T A-TibPs.b /
Professional or Technical Organization Memberships: 5$ /4AptT1 ONA-t_ /. count A-TZge4-e
Pr A-C 1177 09-ppa C q=rzoAs
Civic or Community Experience, Membership, or Previous Public Service Appointments:
iL iA t�Q t rZ C►xa•�i iD�D7:_er e .� �r ��
Experience or Special Knowledge Pertaining to Area of Interest:
6- Pi -DI U tc'a.►444-
Have you ever been convicted of a crime? No: Yes:
Date: tat" tiSr"3a, .20 l( Signaturt,./Drin
a._...............6;:::A.s.,..._....,
Please feel free to provide additional information or letters of endorsement.
Please return completed form to:
Office of the City Clerk
1243 National City Blvd, National City, CA 91950
Thank you for your interest in serving the City of National City.
* Residency requirements may not apply
This documents is filed as a public document Revised: 12/02/10
EDUCATIONAL HISTORY AND COMMUNITY INVOLVEMENT
EDUCATION
Master of Arts in Education 1985 USIU
Reading Specialist Credential 1985 USIU
General Elementary Credential 1963 SDSU
AB Degree-Spanish/Anthropology 1962 SDSU
POST -GRADUATE STUDIES (1986-1990)
University of California, San Diego
University of Missouri, St. Louis
TEACHING EXPERIENCE
Chula Vista School District
John J. Montgomery Elementary School - Language Arts Specialist
National School'pistrict
Parents as Teachers Program - Community Parent Educator
San Ysidro School District
La Mirada Elementary School - Reading Lab
Spanish and English Reading Transitional Program
Chula Vista School District
Travelling Spanish Teacher
Sixth Grade/First Grade Teacher
COMMITTEES AND ORGANIZATIONS (1973-1990)
President, National City Public Library Board of Trustees
Board Member, National City Public Library Board of Trustees
Board Member, Families for Literacy Project
Board Member, Project Read
Board Member, Project My Turn Advisory Board
Sweetwater District GATE Advisory Committee
Sweetwater District Advisory Committee on Curriculum & Instruction
Sweetwater District Desegregation Committee
Sweetwater District Lau Steering Committee
Hilltop High School GATE Parent Advisory Committee
National School District Citizens' Integration Committee
National School District Parent Advisory Committee
National School District District Desegregation Committee
National School District Lau Steering Committee
National School District Bilingual Parent Advisory Committee
National School District Bilingual Education Committee
Kimball School Parent Advisory Committee
Kimball School Bilingual Parent Advisory Committee
President, Vice -President, Secretary, Treasurer
National School District/National City Community Mini -Park Committee
National City/Tecate, Mexico Sister City Committee
BOARD OF TRUSTEES OF THE NATIONAL CITY PUBLIC LIBRARY (1985-1990)
Appointed by the Mayor and the National City Council
Trustees determine policy relating to the operation and
administration of the library.
ADVISORY BOARD OF FAMILIES FOR LITERACY PROJECT (1988-1990)
Literacy program for parents and children
ADVISORY BOARD OF PROJECT READ (1986-1990)
Literacy program for adults
ADVISORY BOARD OF PROJECT MY TURN (1986-1988)
Project My Turn, funded by a California State Library grant, is a
library -based tutorial program for junior high school students.
Junior high school students are given an opportunity to receive
one-on-one assistance from trained tutors.
Appointed by Library Board of Trustees to represent National City
Library
ACCELERATED BILINGUAL CLUSTER PROGRAM (1985-1987)
Volunteered in National School District's Advanced Bilingual Class
Presented study units and assisted classroom teachers and students
with independent study on class topics
Curriculum consisted of Lacivanced instruction in reading, math and
spanish
PARENT VOLUNTEER COORDINATOR (1974-1980)
Organized Bilingual Parent Volunteer Program for Kimball Elementary
School, National School District
Presented bilingual workshops to parents
Trained parent volunteers to work with students and teachers
COMMUNITY WORKSHOPS (1974-1980)
Presented workshops at County Education Center regarding Parent
Volunteer Programs in Bilingual Schools
Presented workshops for San Diego State Institute for Cultural
Pluralism Lau Center regarding Parent. Volunteer Programs in
Bilingual Schools
TESTING TEAM EXPERIENCE (1969-1972)
Ed Snyder and Associates
Member of testing team with Ed Snyder and Associates
Tested students in Spanish and English at Norwalk/La Mirada School
District
Independent field study and language dominance survey for Bilingual
Education Programs for the state of California
CITY OF NATIONAL CITY
APPLICATION FOR APPOINTMENT
TO CITY BOARDS, COMMISSIONS, AND COMMITTEES
Civil Service Commission
Community & Police Relations Commission*
Library Board of Trustees
Parks, Recreation & Senior Citizens Advisory Board
Planning Commission
Public Art Committee*
Traffic Safety Committee
Sweetwater Authority
Note: Applicants must be residents of the City of National City except for those marked by an *
Name: e-c' (J' gill )7
Home Address: O2 5 - ? l w,-vF
TeL No.(&( j>t1477 -S6,y 7
Business Affiliation: it/4 Title:
Business Address: /L 4- Tel. No.:
Length of Residence in National City: '5 1f,, San Diego County:s)r/S California:
Educational Background: Y - Y r.5 C be- '-
Occupational Experience:
frr)/1�. 47 Ai Al
Professional or Technical Organization Memberships: ivo v�
Civic or Community Experience, Membership, or Previous Public Service Appointments:
-/412-7-2-> /%PH lz* aF- -7F�,l /a- yibe-ris -P.Ud% ntc-Pe
Experience or Special Knowledge Pertaining to Area of Interest:
/`fflA) v6.7 - 'lee 4-7 1-Joif2 / ,,
Have you ever been convicted of a crime? No: Syr Yes:
Date: 3////i(
7, ,l/ 17- o2 5--
Signature:
Please feel free to provide additional information or letters of endorsement.
Please return completed form to:
Office of the City Clerk
1243 National City Blvd, National City, CA 91950
Thank you for your interest in serving the City of National City.
* Residency requirements may not apply
This documents is filed as a public document Revised: 12/02/10
to
Civic or Community Experience, Membership, or Previous Public Service Appointments:
16 ,�Z/'ar 7/N/i'6- U m124S V
Experience or Special Knowledge Pertaining to Area of Interest: /!//
Have you ever been convicted of a crime? No:
Date:
Signature:
Yes: iz&-).0 r/-J
/1/1 ff S add
Please feel free to provide additional information or letters of endorsement.
Please return completed form to:
Office of the City Clerk
1243 National City Blvd, National City, CA 91950
Thank you for your interest in serving the City of National City.
• Residency requirements may not apply
This documents is filed as a public document
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CITY OF NATIONAL CITY
APPLICATION FOR APPOINTMENT
TO CITY BOARDS, COMMISSIONS, AND COMMITTEES
Civil Service Commission
Community & Police Relations Commission*
Library Board of Trustees
Parks, Recreation & Senior Citizens Advisory Board
Planning Commission
X Public Art Committee*
_ Traffic Safety Committee
Sweetwater Authority
Note: Applicants must be residents of the City of National City except for those marked by an *
Name:
Pog4
Home Address: 27 o I k,S7: SD Cc( p1 z Tel. No.:
Business Affiliation:-.34-1(361" ,urn C Sa6j0( Title: (/CCU
Business Address: .1 13 17 z (=LH— • �4_3C, C4-gi9 SPel. No.: 6 tq 26 J 6
Length of Residence in National City: .cc San Diego County: 2'1 California: 6 2✓
Educational Background:
'--sYcl- -oz_c3 c4.S A.)xteT
S T*/ azty,iE ? / t Y
Occupational Experience: P. (�I�{�/� _ 2
Professional or Technical Organization Memberships: �'cti[C 3 t F ¢,Qlic76� CGj'1f �
e efP c Cry , cc7c. (DE726;Lize-Yerzr
S,y�OI CU2
11
CITY OF NATIONAL CITY
APPLICATION FOR APPOINTMENT
TO CITY BOARDS, COMMISSIONS, AND COMMITTEES
Civil Service Commission
Community & Police Relations Commission'
Library Board of Trustees
Parks, Recreation & Senior Citizens Advisory Board
Planning Commission
Public Art Committee'
Traffic Safety Committee
Sweetwater Authority
Note: Applicants must be residents of the City of National City except tor those marked by an '
Name: , ( kR9 c or k YYN.
Home Address: 15-) q ,70
j-
TeL No_: )9 """ 65GQ- 3 ° 8"1'
Business Affiliation: t�e-� t 'I QC� Title:
Business Address:
Tel. No.:
Length of Residence in National City. 50 ± San Diego County: 6 9 California: 6 C�
Educational Background: VD 1-t 'VI CO. L. L0-19t2 € I N o L S S t
C0 Q fa se c. tYla aLA.99motif.
Occupational Experience: S 'l
o.r Qt� 130Qt .tr
Professional or Technical Organization Memberships:
4,
e "77ony e,vv-
U ctlti� -CA-. ' 7 /--(W e4-4A
k.„,..4
�--(-- p i S a ti C Cec fig .
ri
Date:s'Aj 6 -- 0(( Signature: ,k�_ p u—
"
w ,a__,t S b-e._e NJ isr-i-ev-e_ r{ d f iv U-ic - e fYL 4 4/4K,},
Please feel free to provide additional information or letters of endorsement. g,L
v‘,1 (5)"-V It'Le Tlease et urn coympleted orm)to: 00' J2 A" f
Z 1\4 rick A* ttratO S Office of the City Clerk
p-f ifyliw0.5e MeN� National C' Blvd, National City, CA 91950
J K1 LI, 60L-{ Op c A-rrt C 0IVF.l-4
Thank you for your interest in servin( the City of National City.
aob
"Residency ree uu ervt.ments may" riot ap q b* D+- Wye �6y.�-,et2 lid) Q12--d t C
This documents is filed as a public document Revised. 12/02/10
Civic or Community Experience, Membership, or Previous Public Service Appointments:
My FR.ry.• t..r or a..r-t t N .' e s-f e d A l-t{'e.+, m' s-e-►zu r ni 'j row C'rvl
F3tv-livetz 4_ Brix i-lveVn"'f/ u-e COPS NZA p?r i� Experience or Special Knowledge Pertaining to Areaof Interest: et2 �'��
�.C' rRe`scd-e"A-S. ii.sc-i-t.k BUsrNPSS� _ C' .CS-iec i--r{-{-(--f �� se
pop ►va ec t s `s Sok) bofvo J- d
1 / C, tf-(1'a vcc� ry d s
Have you ever been convicted of a crime? No: I` Yes:
� hive
1�L
CITY OF NATIONAL. CITY
APPLICATION FOR APPOINTMENT
TO CITY BOARDS, COMMISSIONS, AND COMMITTEES
Civil Service Commission
X Community & Police Relations Commission*
Library Board of Trustees
Parks, Recreation & Senior Citizens Advisory Board
Planning Commission
Public Art Committee'
Traffic Safety Committee
Note: Applicants must be residents of the City of National City except for those marked by an
Name: Pear! Quinones
Home Address: _3009 E. 6th Street, national City, CA. Tel. No.: _619.206.9162
Business Affiliation: Sweetwater UHSD Title: Vice President
Business Address: 1130 Fifth Avenue, Chula Vista, CA. 91911Tel. No.: _619.585.4405
Length of Residence in National City: __111981San Diego County: 1961 California: 1981_
Educational Background: _BA —Political Science, Masters Public Administration, Educational
Leadership
Occupational Experience: _Education Dropout Prevention Specialist
Professional or Technical Organization Memberships: _NALEO, CA. School Board Association,
Borderview YMCA, CYAC, HOPE,CWEAR NHU, CLSBA, CSEA
Civic or Community Experience, Membership, or Previous Public Service Appointments: _Appointed
to Congressman Bob Filner's Education Committee, CSBA English Learners, CSBA Public Policy
Committee_
Experience or Special Knowledge Pertaining fo Area of Interest: 1 assisted in the establishment
and implementation of the San Diego Police Review Board in 1989; work closely with various police
departments in my capacity as a Dropout Prevention Specialist and as a Sweetwater Board Trustee.
Have you ever been convicted o1 a crime? No: X Yes:
Date: 1/4/2011 Signature: Pearl Quinones
Please feel free to provide additional information or letters of endorsement.
Please return completed form to:
Office of the City Clerk
1243 National City Blvd, National City, CA 91950
Thank you for your interest in serving the City of National City.
15
CITY OF NATIONAL CITY
APPLICATION FOR APPOINTMENT
TO CITY BOARDS, COMMISSIONS, AND COMMITTEES
Civil Service Commission _ Planning Commission
Community & Police Relations Commission' Public Art Committee'
bLibrary Board of Trustees Traffic Safety Committee
Parks, Recreation & Senior Citizens Advisory Board
Note: Applicants must be residents of the City of National City except for those marked by an
Name: _1� . {-Ni,.
Home Address:
tc A NLAVI 4; Mt., l 1SCE Tel. No.: 6-6 t1 3
Business Affiliation: PJL4i 1f0 Title: Ieta--
Business Address:. D 6, c14111) . fl 1'i4s0 Tel. No_: (7161 y1
Length of Residence in National City: fp (Y V San Diego County: A_I Caiilornia: __
Educational Background: f 1i F4,vik f ��({Z,tS}vI
lliA 1
Occupational Experience:
Professional or Technical Organization Memberships:
Civic or Community Experience, Membership, or Previous Public Service Appointments:
Experience or Spec .1 Knowledge Pertaining to Area of Interest:
i`Lr04i-f')Lts04Q
Have you ever been convicted of a crime? No: V- Yes:
I t1' L 6C A-0-5(
Date: ) 2 1
Signature -
Please feel free to provide additional information or letters of endorsement.
Please return completed form lo:
Office of the City Clerk
1243 National City Blvd, National City, CA 91950
Thank you for your interest in serving the Cily of National City.
• Residency requirements may not apply
This documents is laod as a public document
Revised: October 1, 2009
CITY OF NATIONAL CITY
APPLICATION FOR APPOINTMENT
TO CITY BOARDS, COMMISSIONS, AND COMMITTEES
Civil Service Commission
Community & Police Relations Commission`
,/ Library Board of Trustees
Parks, Recreation & Senior Citizens Advisory Board
_ Planning Commission
Public Art Committee` 2011
Traffic Safety Committee
Sweetwater Authority OITy
Note: Applicants must be residents of the City of National City except for those marked by an
RECEI VED
CI I Y CLERK
MAR ►0 A1D
OF NATIONAL C
Name: Skakt Ur7a�
Home Address: 21 / 7 6- 4 ✓e-- Alt AI' 4".1 el,' GAF. Tel. No.: '/ ?) Z d l - d 72 r
Business Affiliation: etee IW"t. & $ h C d h., fes.. ( Title: e w�er-
Business Address: 1(32. e (42.4 i3/vl. ,'0 1Not T-. - 278 Tel. No.: (61'9 207 -647-r
Length of Residence in National City: S San Diego County: 2. G California: 2- S'
Educational Background:
vh: WrSay/
Occupational Experience:
14;.9k Sckeel ()r
e/ecfr; co-1
/01471' /-e Oe-yrc.
So ti
Co,tira`ctovi e/gc.fr«w 1 /x. ffrie fo✓"
Professional or Technical Organization Memberships: ^/a{-jp k.a 1 e eitA be. Of ea e—
Civic or Community Experience, Membership, or Previous Public Service Appointments:
d. f/� Fia/ //o 4- IA fl1N+ *a / a' ty Ca
Experience or Special Knowledge Pertaining to Area of Interest:
,goaret r+t., b" dir<
Have you ever been convicted of a crime? No: Yes:
* S
R /'.'0
Date: 3 - /o a //
Signature:
Please feel free to provide additional information or letters of endorsement.
Please return completed form to:
Office of the City Clerk
1243 National City Blvd, National City, CA 91950
Thank you for your interest in serving the City of National City.
Residency requirements may not apply
This documents is filed as a public document
Revised: 12/02/10
\5
CITY OF NATIONAL CITY
APPLICATION FOR APPOINTMENT
TO CITY BOARDS, COMMISSIONS, AND COMMITTEES
Civil Service Commission Planning Commission
Community & Police Relations Commission* Public Art Committee*
Library Board of Trustees Traffic Safety Committee
Parks, Recreation & Senior Citizens Advisory Board
Note: Applicants must be residents of the City of National City except for those marked by an *
Name: I C,l-tAR.0
tA)1 F1El_1)
Home Address: Z i Li () 00 AVET. Tel. No.: (fl 1 q -`7 S65 - q 14 q
Business Affiliation: N/A Title: kJ/ 4
Business Address: IkJ/16c Tel. No.: fl.%hq
Length of Residence in National City: a yie5 San Diego County: 3yik Califomia: 3 yg 5
Educational Background: 1-'tit,k 5Li{obL.. pit'i.,OrAA j Coce_etorLy :t=10 t 0LLFC
Occupational Experience: -PAtiurr✓K., Lt)RliLli`! tJ.,�a, I,JAV�t Etc V� 4-(ZInix f
Professional or Technical Organization Memberships:
Civic or Community Experience, Membership, or Previous Public Service Appointments:
Votvrvrm(z s++;T ! A-E.ADO:›E (1.R.e K. ANT r ► CAW FAgnA
Experience or Special Knowledge Pertaining to Area of Interest:
% et:& -Ly ii2:4)U+Ni-, A D t.s hNifi2o(U EIUTA(-. t_AU)
Have you ever been convicted of a crime? No: X Yes:
Date: Signature:
Please feel free to provide additional information or letters of endorsentt.
Please return completed form to:
Office of the City Clerk
1243 National City Blvd, National City, CA 91950
Thank you for your interest in serving the City of National City.
* Residency requirements may not apply
This documents is filed as a public document
✓ rn
-Cc)
• r7rei
o r- C
Revised: October 1, 2009
k6
CITY OF NATIONAL CITY
APPLICATION FOR APPOINTMENT
TO CITY BOARDS, COMMISSIONS, AND COMMITTEES
Civil Service Commission
Community & Police Relations Commission'
Library Board of Trustees
Parks, Recreation & Senior Citizens Advisory Board
_ Planning Commission
t/' Public Art Committee'
Traffic Safety Committee
_ Sweetwater Authority
Note: Applicants muss be residents of the City of National City except for those marked by an '
Name: kielJ .
Nome Address: 41 b E.. PLAZA %M 4./4
Business Affiliation:/N7 CHrTrS!%rtiu OuTER.
Tel. No.: C.; l0 U -u
vex art_
Title: Hrt?r/Id i RJr�s?or�r�r oar
Business Address: 036 Sad hr ,C Hut It- U i) CAA . Tel. No.:
Length of Residence in National City: fry yte5 . San Diego County: •4 fP-.California:
Educational Background: ASSpc•1rL hlP efurF-T- rt lot -uC,.= hN,) el-'I.PEER.;
t
•Y ✓ 9 } clziA,c0 P ja, rt,rN�trzer�re�7 = )CUy
Occupational Experience: ,+A() SfrrP ruses/En_ raw
4tr2_, Cxtir<IEI Tn1r-uS/ rr a..• r,✓ / : s5 - r `z�2 Grtri�e �hi� cfais r DLt.prz_
Professional or Technical Organization Memberships: /fAal,Yyrysr/v CLUB as- 4-1-1;c,t
Civic or Community Experience, Membership, or Previous Public Service Appointments:
Nh71v(�r� ? I T A-c,,U { r2 frt./S C 0r'rrlii7 t
Experience or Special Knowledge Pertaining to Area of Interest:
e 412 .• TrfriACE3.2_ /•00 tDOtLiS11c. - rvcuC_14,t1-101.;
Have you ever been convicted of a crime? No: )( Yes:
Dale: 0/-d-13-�o!/
Signature:
Please feel free to provide additional information or letters of endorsement.
Please return completed form to:
Office of the City Clerk
1243 National City Blvd, National City, CA 91950
Thank you for your interest in serving the City of National City.
' Residency requirements may not apply
This documents is filed as a public document
tlevised: 12/02/10