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2014 Board and Commission Application Cityi f <br /> Page 3 of 4 Louisville <br /> cumu o.'INCE 1117 <br /> SCHEDULING CONFLICTS: <br /> What times Monday through Thursday are you generally unavailable to attend meetings? <br /> (The meeting times of each board are available on the City's web site at <br /> www.LouisvilleCO.gov.) <br /> 5amto4pm <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 /> pending against you? Exclude minor traffic violations?OYES ONO If yes, list for each <br /> case: <br /> (1) date of offense; (2) charge; (3)jurisdiction; (4) court name and (5) disposition: <br /> ten years, has your driver's license in any state ever been suspended or <br /> Within the last y y y p <br /> revoked, or have you ever been denied a drivers license in any state?OYES ONO <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?OYES ONO If Yes, please explain below: <br /> Do you or a company you work for or own do business with the City of Louisville? <br /> OYES ONO If Yes, please explain below: <br /> • Al Board and Commission members serve without compensation. <br /> • Anyone applying to a Board or Commission is subject to a background check. <br /> • The City may reject an applicant for any lawful reason.An appointed Board or <br /> Commission member may be removed during his/her term of office for cause <br /> as defined in the City Charter and Resolution No. 16, Series 2009. Reasons for <br /> rejection or removal from office Include,without limitation,where a background <br /> investigation reveals an arrest, conviction,or pending charges for a criminal <br /> offense (excluding minor traffic violations). <br /> • Al information on this application is public record and may be released for <br /> public review. <br /> • Questions about a board/commission or the application process may be <br /> directed to Meredyth Muth at MeredythM @Lou€svilleCO.gov or 303.335.4536. <br /> 43 <br />