Laserfiche WebLink
13065 Orono 14rh y <br />763.635.1000 <br />APPLICATION FOR REAPPOINTMENT TO CITY <br />ADVISORY BOARD/COMMISSION <br />Reappointment to: T' I n o r, I n o f rltil/Yi 1�`SLQ <br />APPLICANT INFORMATION <br />/ (, <br />Name: a I I CA,r140 City of Residence:f4'�j{ r <br />Occupation: JSp? el "1_m ffionrArjPr Employer: r i I _ <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 />(41y, 14 t9C� Cre«ita S0&9*0- s -thy vivrk--r- r,&-mm-mmRelev nt Experience: Please describe your educational, professional, civic, or community <br />participation, which may be relevant in serving on this board/,commission. r <br />if <br />WAK <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? 0 Yes ❑ No <br />Comments: Ir <br />gare6k9 C-0 covnca/(aS77 7 <br />tv�IHvedj dv�-;� ,'?•1,� 3 v dxr <br />Conflict o Interest is defined as the participation in any activity, recommended action, or decision <br />from which the indiv dual 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 interestany business, <br />however organized, which could be construed as a conflict of interest? El Yes No <br />If yes, provide details on a se crate RLeze of paper. <br />%�a3 -7 <br />A licant S a e 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 Expires: _ <br />❑ Not Reappointed <br />