City Council Agenda and Packet 2013 12 09-11 BCC INTERVIEWS

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�lt of 2014 Board and Commission Application Page 3 of 4 1" -m Louisville �ULoRAL`U•SINCL IH:u SCHEDULING CONFLICTS: What times Monday through Thursday are you generally unavailable to attend meetings? (The meeting times of each board are available on the Citys web site at www.LouisvilleCO.gov.) DISCLOSURES: Within the last ten years, have you ever been convicted of a came or received a suspended sentence, deferred sentence or deferred prosecution, or forfeited bail, for any offense in criminal or military court, or do you have any criminal charges currently pending against you? Exclude minor traffic violations. ❑YES NO If yes, list for each case: (1) date of offense; (2) charge; (3)jurisdiction; (4)court name and (5) disposition: Within the last ten years, has your driver's license in any state ever been suspended or revoked, or have you ever been denied a driver's license in any state? ❑YES £NO If Yes, please explain below: Have you ever been involved in an incident involving child/elder abuse or child/elder neglect for which a report was filed with or issued by any law enforcement agency or social services agency? ❑ YES l NO If Yes, please explain below: Do you or a company you work for or own do business with the City of Louisville? ❑ YES 5r NO If Yes, please explain below: • All Board and Commission members serve without compensation. • Anyone applying to a Board or Commission is subject to a background check. • The Oily may reject an applicant for any lawful reason.An appointed Board or Commission member may be removed during his/her term of office for cause as defined in the City Charter and Resolution No. 16, Series 2009. Reasons for rejection or removal from office include,without limitation, where a background investigation reveals an arrest, conviction, or pending charges for a criminal offense (excluding minor traffic violations). • All information on this application is public record and may be released for public review. • Questions about a board/commission or the application process may be directed to Meredyth Muth at MeredythM @LouisvllleCO.gov or 303.335,4536, 26