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MI! 1 9 2016 <br />APPLCA700N FOR REAPPOWY MIENT TO CITY <br />ADVOSCRY BOARD/COMMISSDON <br />s � <br />73f3G5 01— ]'arktvah � <br />�r Reappointment to: % .�j" �✓" ss �� <br />763.635.100* <br />APPLICANT INFORMATION <br />Name: f' all `� %4111e5 -r <br />City of Residence: F- "' <br />Occupation: Sr. l'/ro�hL+�/ �,�ds (���i4t <br />P Employer: cicd:1; l <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/conimssio <br />��,EJ <br />14 '06 VII/ <br />Attendance: Are your aware of the importance of regular meeting attendance including the time <br />commitment involvedA <br />'preparing for meetings, and do you feel you have the time available to be <br />an active participant? 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? ❑ Yes ❑ No <br />If yes, provide details on a sel2arate iece of paper. <br />Applicant Signature Date <br />Applications will be kept on fide for one year; after that time, anew application must be filed. <br />OFFICE USE ONLY <br />Council Meeting Date: <br />❑ Reappointed <br />Term Expires: <br />❑ Not Reappointed <br />