10.1. SR 02-02-2015 - Laserfiche WebLink

Home Browse Search

JAN 5 'r` APIF OCATION FOR REAPPOINTMENT TO 0TY Oty of ADVISORY BOARDICOMMISSION River Reappointment to, k S 13065 0-Parkway 763.635.1000 APPLICANT INFORMATION Name: _6 U 0—k 141(t, A'0 City of Residence: L V Occupation: ' -r rL t�-o Employer: Statement of Interest: Please state briefly why you are interested in continuing to serve on the board/commission for which you are seeking reappointment. -1`n i '`�,� S i tj v.s t r—V- E 0 6 f kti4 5 ul i'Z C �7 �. a l L_[ rtt 4 J r LIB a 1 V G',Zt S . e,/LK To t-6A-+L" o t' t-E co/v.ft l s s f' Relevant Experience: Please describe your educational, professional, civic, or community participation,which may be relevant in serving on this board/commission. d tZ 1 t ix C_• , c L 4- c3 v't t-+ dt' 6,LTS 7 0 A- p V ti �v L V �Zl V C A, W N D y v A W y4 A pi-r © K T-1-+t- fk a V-S i N 4-t,k lZ l U f-'ti _ Attendance: Are your aware of the importance of regular meeting attendance including the time commitment involved in preparing for meetings, and do you feel you have the time available to be an active participant? ® Yes ❑ No Comments: Conflict of Interest is defined as the participation in any activity, recommended action, or decision from which the individual has or could have the potential to receive personal gain,whether it be direct or indirect. (See at-Lached "Conflict of Interest" Ordinance) In accordance with this definition, do you have any legal or equitable interest in any business, however organized,which could be construed as a conflict of interest? ❑ Yes 0 No If yes, provide details on a separate pkce of paper. Applicant Signature Date Applications will be kept on file for one year;after that time, a new application must be filed. OFFICE USE ONLY Council Meeting Date: ❑ Reappointed Term Expires: ❑ Not Reappointed