Laserfiche WebLink
APPLICATION FOR REAPPOINTMENT TO CITY <br /> City of ADVISORY BOARD/COM MISSION <br /> RiVer Reappointment to: //�X?A? <br /> 13065 Orono Pnek—y <br /> 763.635,1000 <br /> APPLICANT INFORMATION <br /> Name: City of Residence: !�/A' <br /> Occupation: rd Employer: <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 /> par 'cipation,which may be relevant in serving on this board/>coIn op. <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? 0 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 could be construed as a conflict of interest? LJ Yes 8 No <br /> If yes,provide details on a sea e iece of 12al2er. <br /> Appli t Signat Date <br /> Applications will be kept on file for one year,after that time, anew application must be filed. <br /> OFFICE USE ONLY <br /> Council Meeting Date: <br /> El Reappointed <br /> Term Expires: <br /> Not Reappointed <br />