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<br />Applicatiofl - Page 2 <br /> <br />Applicant Name: lv/ark A. Carmel <br /> <br />Do you have a valid Drivers License? <br /> <br />Have YOll been furested or convicted of a criminal offense (excluding minor traffic offenses). If yes, please <br />explain L~e circumstances: <br />NO <br /> <br />Desired Salary: 155,000 <br /> <br />Availability: June 1,2007 <br /> <br />Is there a CUlTent employer that you do not wish us to contact unless you are a finalist? <br />No <br /> <br />How would you like us to contact you?Phone or email <br /> <br />I certify that all statements on my application and other materials are true to the best of my knowledge. I <br />understand that falsification or omission of information relevant to employment or failure to fully complete the <br />IPplication form may disquaiify my application. I agree and give my consent that if I am a semifinalist that <br />any person, firm or organization listed herdn is authorized to furnish the Prothman Company with reference <br />material concerning my character, past employment or any other information requested. I understand and <br />agree that the hiring agency or its agents retains the right to determine the fitness and adaptability of applicants <br />for employment. <br /> <br /> <br />Date:April ] 9, 2007 _ <br /> <br />References: Please list six references including supervisors., subordinates and peers: <br /> <br />Name Relationship Reference Contact <br />Phone Number <br />Mary Mohorich Subordinate, Pueblo County Clerical Staff 719-583-6000 <br />James Spaccamonti Supervisor, President Economic Development Corporation 719-544-2000 <br />John Klomp Supervisor, Chair, Board of COlmty Commissioners 719-543-2043 <br />Jerry Gamer Peer, Greeley Chief of Police 970-397-8175 <br />Steve Bagley Subordinate, Greeley City Engineer 970-539-5880 <br />I Larry Kallenburger Peer, Executive Director Colorado Counties, Inc. 303-861-4076 <br />