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<br />~•1~~1r <br />APPLICATION FOR REAPPOINTMENT TO CITY <br />aty of ADVISORY BOARD/COMMISSION <br />Elk -`-1 <br />..•.r., <br />River ~ ~~~~~~~ `s~~r~~l~(~~fC`~ <br />Reappointment to: <br />13065 Oxono Pukway <br />763.635.1000 <br />APPLICANT INFORMATION ~ f ~j <br />Name: t )~~ ~~~~`~~f ~~ City of Residence: C~ _.I- 1~.~ ~i`~~ <br />rr <br />Occupation: ~t~~ I ~`~ '~~~ C.~ Employer: ~~~~ 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 />'~~ <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 />-~,h~~owever organized, which could be construed as a conflict of interest? ^ Yes ^ No <br />~~ es, provi~e~detail~ on a se arate iece of a er. <br />~~~I~ <br />Applicant Signature Date <br />Applications will be kept on file for one year; after 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 />Statement of Interest: Please state briefly why you are interested in continuing to serve on the <br />board/commission fox which you are seeking reappointment. <br />Relevant Experience: Please describe your educational, professional, civic, or community <br />participation, which may be relevant in serving on this board/commission. ~ <br />