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2017 BRaD Application <br />Page 3 of 4 <br />DISCLOSURES: <br />M: City,/ <br />Louisville <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 <br />bail, for any offense in criminal or military court, or do you have any criminal <br />charges c rrently pending against you? Exclude minor traffic violations. <br />0 YES <br />charges, <br />If yes, list for each case: <br />(1) date of offense; (2) charge; {3} jurisdiction; {4} court name and (5) disposition: <br />Within the last ten years, has your driver's license in any state ever been <br />suspended or revoked, or have you ever been denied a driver's license in any <br />state? 0 YES KNO <br />If Yes, please explain below: <br />Have you ever been involved in an incident involving child/elder abuse or <br />child/elder neglect for which a report was filed with or issued by any law <br />enforcement agency or social services agency? 0 YES Ti NO If Yes, please <br />explain below: <br />Do you or a company you work for or own do business with the City of Louisville? <br />❑ YES NO If Yes, please explain below: <br />liei 001- wwlfec vvw rn e Gl - -1 d f- 1-0 1.7i 11-t i v fueicut hn <br />1!{ i PeLb 5 �. <br />• All _Committee members serve without compensation. <br />• Anyone applying is subject to a background check. <br />• The City may reject an applicant for any lawful reason. An appointed <br />member may be removed during his/her term of office for cause as defined <br />in the City Charter, Resolution No. 16, Series 2009, and Resolution No. 59, <br />Series 2016. Reasons for rejection or removal from office include, without <br />limitation, where a background investigation reveals an arrest, conviction, <br />or pending charges for a criminal offense (excluding minor traffic <br />violations). <br />• All information on this application is public record and may be released for <br />public review. <br />5 <br />