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~'' APPLICATION FOR REAPPOINTMENT TO CITY <br />cty of ADVISORY BOARD/COMMISSION <br />Elk <br />-~.-~ <br />R1Ver Reappointment to: ~=.-`t'om!' ~~~!mn't <br />13065 Oiono Pazkway.' <br />763.635.1000 <br />APPLICANT INFORMATION <br />Name: F°~~~ ~-~ ~~~ City of Residence: ~~ ~~~~~ t3f~~ ~_~-~~ C~'~-"'-S h~~' <br />+ ~ <br />Occupation: ~~u~~v°' / ~'`~~~c•t;~-~i Employer: ~.u. ~b~5~~.~ .~'v1~. <br />Statement of Interest: Please state briefly why you are interested in continuing to serve on the <br />board/commission for which you are seeking reappointment. <br />Relevant Experience: Please describe your educational, professional, civic, or community <br />participation, which maybe relevant in serving on this board/commission. <br />~Erv-~ iS f4~ i l~rc..r L®~/ ~~ifrJCSS caWsq~6'2 ~ ~1rfVPs_ ~~L~16~® <br />~''~irt~S Gtr !~d'~ in~ ~,-r~rnc5~= mar ~vc~ ~~ ~'E~.~c~ ct~aC.. <br />raG~cr~.t -~r~~ ter, ~'~-~ ~ ~-4;~1-~ s~~~, r t-~ ~ ~. ~3~~ ~~5 <br /> <br />Attendance: Are your aware of the importance of regular meeting attendance including the time <br />commitment involved ~ preparing for meetings, and do you feel you have the time available to be <br />an active participant? Yes ^ No <br />Comments: <br />Conflict of Interest is defined as the participation in any activity, recommended action, or decision <br />from which the individual has or could have the potential to receive personal gain, whether it be <br />direct or indirect. (See attached "Conflict of Interest" Ordinance) <br />In accordance with this definition, do you have any legal or equitable interest in any business, <br />however organized,-which coald be construed as a conflict of innterest? ^ Yes No <br />If yes, pro ' e de ~ o a se arate iece of a er. <br />~_/~- ~'/ <br />Applicant Signa Date <br />Applications will be kept on frle for one year; a8er that time, a new application must be filed. <br />OFFICE USE ONLY <br />Council Meeting Date: <br />^ Reappointed <br />Term Expires: _ <br />^ Not Reappointed <br />