Laserfiche WebLink
JA N z z <br />2016 <br />APPLICATION FOR REAPPOINTMENT TO C= <br />City of ADVISORY BOARD/COMMISSION <br />Elk <br />er Reappointment to:CZ-rF X66-SE.-eVAT[oA--3 <br />13065 0-0 ]°—r, ay <br />763.635J000 <br />APPLICANT INFORMATION <br />Name: --J cs�H City of Residence:�r <br />Occupation: r5���r�AL - ti �`r. �T Employer:/' XJ //is7-,,<1<- C fcrE:�- <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 />77 1L'CA,.P 7%or" Lel vC�riTy <br />'7- •/E Z /KK5 0A,-1 S T. z.v A7"<* To(.,.) e,e <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? L10 Yes LIN. <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 i of 12aper. <br />Applicant Signature <br />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 />❑ Reappointed- <br />Term <br />eappointedTerm Expires: <br />❑ Not Reappointed <br />