Laserfiche WebLink
`✓ APPLICATION FOR REAPPOINTMENT TO CITY <br /> City of ADVISORY BOARD/COMMISSIO <br /> o <br /> Reappointment to: fl Wiz_ ���.. ese Uci-! t •� 0 7, yw, .q a,'c� <br /> 13065 Orono Pnk�vay.' , <br /> 763,6.35.1:000 ... <br /> APPLICANT INFORMATION <br /> r <br /> Name: t"c V En.a,CN City of Residence: 614' �'=o e,- <br /> occupation: /-us-{ 1'YIcz✓seas, ca— Employer: Ccn kei \ Sc!-- .s-Pr;1 k � <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 /> \,i'e. r 0!\, .0 CJ !1 sV9,1 i .t.' .f\ 1 .S Ci l 1 •�°cl t f 1i o4 A- )P C ;..l.l� ��'C'/t^I� Yt <br /> 1 <br /> k", CG -1 0 1_ft r. :(.lie,. C ` .i� e C ✓✓+ aJ„ '. d�C, S Gv� L,� <br /> 12 U_C!/)t._i_.I .✓\ (5'111. A",L),?r -to <br /> Relevant Experience: Please describe your educational,professional, civic, or community <br /> participation,which may be relevant in serving on this board/commission. <br /> .:J ka ;c_ .S eC-\YCz0 � � s l�� C c� .� .�`,5��'L? � S, n��3 �t7r� ..°� � 17 (QL.,J.'hc,re. <br /> °l. <br /> /i !:a oc-) I an f J\ r e'\ Qr \i <br /> \i <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 LJ No <br /> Comments: Me e 4, S CA C e c;°U C o 0 19 e,>\ e c3 4- 0 r)-\ <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? 0 Yes EI No <br /> If yes,provide details on a separate Rjece of 12al2er. <br /> x ..21 <br /> Applicant Signature Date <br /> Applications will be kept on file for one year,after that time, a new application must beffled. <br /> OFFICE USE ONLY <br /> Council Meeting Date: <br /> El Reappointed <br /> Term Expires: <br /> Not Reappointed <br />