|
2014 Board and Commission Application IL: City,,',
<br /> Page 3 of 4 Louisville
<br /> What times Monday through Thursday are you generally unavailable to attend meetings?
<br /> (The meeting times of each board are available on the CiWs web site at
<br /> LouisvilleCO.gov.) {'
<br /> DISCLOSURES:
<br /> Within the last ten years, have you ever been convicted of a crime or received a
<br /> suspended sentence, deferred sentence or deferred prosecution, or forfeited bail, for
<br /> any offense in criminal or military court, or do you have any criminal charges currently
<br /> ncnrlinn ^.nninc+,,n,,'? r.-^1•,r4^. mir,r•r+7,-"ffi • •irl-+Innc 11 Vrc in If„nc tic+fnr
<br /> each case:
<br /> (1) date of offense; (2) charge; (3)jurisdiction; (4) court name and (5) disposition:
<br /> I
<br /> Within the last ten years, has your driver's license in any state ever been suspended or
<br /> revoked, or have you ever been denied a driver's license in any state? ❑YES NO
<br /> If Yes, please explain below:
<br /> Have you ever been involved in an incident involving child/elder abuse or child/elder
<br /> neglect for which a report was filed with or issued by any law enforcement agency or
<br /> social services agency'? ❑ YES ENO If Yes, please explain below:
<br /> Do you or a company you work for or own do business with the City of Louisville?
<br /> ❑ Yj �'NO. If Yes, please explain bel w:
<br /> 1 fP v l 6-v-5i'y kI(iL WzrICL 1---,i- L- (r ✓Q p ,0:-/4_ c_ Y
<br /> t,_
<br /> ,'e, 6-/--,c/-1 c of l ex.lo rL r oS -c
<br /> . a m ("Orr-0-14-4, V
<br /> • All Board and Commission members serve without compensation, .vOrku aS 6141- -S[-'.
<br /> • Anyone applying to a Board or Commission Is subject to a background check.
<br /> . The <-4,,--. _!c.-, --r• re-,r!l..-r-ir+f"r,--:m;!rsut::! rc.r•cenr Er. ,,rarv�lr+cpt D .i-crn nr
<br /> Commission member may be removed during his/her term of office for cause
<br /> as defined in the Ctty Charter and Resolution No. 16, Series 2009. Reasons for
<br /> rejection or removal from office Include,without limitation,where a background
<br /> 'r".� _tgr7,ttc^, reveals an arrest, conviction, or pending charges for a criminal
<br /> ._-.,,_ f.:::,;-!;:-Nri; r.^!r. .,-',r-;'f;r v9r ,ttnrc)
<br /> • All Information on this application Is public record and may be released for
<br /> public review.
<br /> 1
<br /> . n,.,(44,,,,,,-.1...,.h r 1..........1./.1..........1./...........7.1,r1.-.7 .41...... 7711-7...4I-7 .1.7 I
<br /> JI.....1-..J s.. Rs.....a..u_ •...,.t. � . a�.�J..ss..•rS1 -..,.. JII..r , ,_. . __ nnn nnr •rnr
<br /> 31
<br />
|