|
~~~ APPLICATION FOR REAPPOINTMENT TO CITY
<br />cty or, ( ADVISORY 130ARD/COMMISSION
<br />~~,
<br />•Ver Reappointment to: ~ ' ~ his i~.Si ~~
<br />13065 Oxono Yukway
<br />763.635.7000 - -
<br />APPLICAN~TjINFORMATI ON
<br />Name: ~-fR ~ ~~ City of Residence: ~i~' ~ vex
<br />~---
<br />Occupation: Jc,~y2>~~~~ Employer: <~f~ ~~., i~,~~a`~ '<~~.~-~ Yw~".~,~
<br />Statement of Interest: Please state briefly why you are interested in continuing to serve on the
<br />board/commission for which you axe seeking reappointment.
<br />_ ~ e? sra JIJ7FCr~ ~ ~ e it ir, 5~~u ~c fur ara Y ^= fw eCl . ~ ~ ~ sf Q ~f~e. +'S Gin T ~C c ~ /'~' U't!.
<br />,~ ~e. /e`~v~ ~c,-~ ~.s s~ ~ ~- ~ifc,.>r'.'~/ ~n ~f,'f ,~'`,« f~~1 Z tdr.'s ~ ~a ~ ltia-, ~~ ~ ~~-~ L.*~~.{~
<br />Relevant Experience: Please describe your educational, professional, civic, or community
<br />participation, which may be relevant in serving on this board/commission.
<br />~`CF~VL G'c~n.t-:9/t/'°~f Lxh ~ 7G°~,,. c~*t ~l~ifs~ZF~.s C-.G>b4-+. S G ~ L.O'.~~ d~<- i`CG>
<br />/~/JJ T / J // ,~e--{vsi,,~-
<br />etit s /` 1 L !~. jVi~'. ~ SG , G Cs ~ ~ .t ~'.sG/ / YE .. .~1'%C A J.
<br />~'i
<br />~/i./ih,y G° iii jr ~rrrj'~~ajj+&swS. 1'~ Gv.-~c..s f /f awr- d~.t~i/ aus+~ ~,,Ss'n ca j i.-1h' < 1. Gr., cclS ~i,. tr~trJ`f~hr~.i
<br />R~lz,~/ /SS,+LS r~,,y- ~°j~e,.a„~- ~-~-~ 7~ 4aro....-;:sS:e,^~ , 'l~
<br />Attendance: Are your aware of the importance of regular meeting attendance including the time
<br />commitment involved in preparing for meetings, and do you feel you have the time available to be
<br />an active participant? ~ Yes ^ No
<br />Comments: -~ ~t.1,~cv~ t ~.~~ ~f s~,,~sul ~ .~„ y ~ ~
<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 defuution, do you have any legal or equitable interest in any business,
<br />however organized, which could be construed as a conflict of interest? ^ Yes ,~ No
<br />If yes rovide details on a se arate iece of a er.
<br />/- d3 - Z~/f
<br />Applicant Signature Date
<br />Applications will be kept on file for one year; aRer 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 />
|