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APPLICATION I T TO CITY <br /> City of ADVISORY BOARD/COMMISSIO <br /> El - - <br /> River Reappointment to: LL <br /> 13.066 0iono P"kway <br /> 763.63$;1000 <br /> APPLICANT INFORMATION <br /> A <br /> Name: //l e�P, �b- ),!Lz City of Residence: <br /> i <br /> Occupation:_Jo tee.. s 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 /> participation,which may be relevant in serving on this board/commission. <br /> '�- <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 El 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? Ll Yes ANo <br /> If yes,provide details on a separate iece of oaner. <br /> 'Z-- � <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 /> El Reappointed <br /> Term Expires: <br /> Not Reappointed <br />